The Application And Economic Analysis Of POX Combined With Cardiac Auscultation In Newborn CHD Screening In Yan'an Area

Objectives:1.Investigate the incidence and composition of newborns' CHD in Yan'an area.2.Compare the cost-effectiveness of POX combined with cardiac auscultation technology(“dual-index” screening technology)and cardiac B-ultrasound in CHD screening,evaluate the effectiveness and economy of POX combined with cardiac auscultation screening strategy,and provide scientific basis for popularizing this screening method.3.Popularize and apply the economical and effective newborns' CHD screening technology in Yan'an area.Methods:Chapter One:1.Randomly select five hospitals in Yan'an area(selected according to the 5directions of east,south,west,north and middle),10,359 live newborns in the five obstetric hospitals from December 2018 to December 2019 were selected as the research subjects.2.A double-blind POX and cardiac auscultation examination were performed by trained and qualified neonatal doctors and senior nurses at 6-72 h after birth,it is divided into 3 groups according to the positive screening criteria:(1)Group A(murmur group):positive cardiac murmur alone;(2)Group B(POX abnormal group): POX positive alone;(3)Group C(“dual-index” screening group): cardiac murmur and(or)POX positive.3.Performed cardiac B-ultrasonography on newborns with positive screening,and Recheck cardiac ultrasonography onnewborns with positive B-ultrasonography examination,the newborns who were both positive were diagnosed.Compare the differences rate and diagnosis rate in CHD's detection among the three groups.4.Compare the incidence of CHD by different gender,birth weight and gestational5.Analyze the risk factors of the early stages of pregnancy in the newborns' mothers.Chapter Two:1.A third-class level hospital in Yan'an took cardiac B-ultrasound for live newborns in the hospital,selected 5091 live newborns in the obstetrics from December 2018 to December 2019 as the research objects.Cardiac B-ultrasound were examined by the trained and qualified cardiac ultrasound doctors and recheck cardiac B-ultrasonography after three months for the positive subjects,the newborns who were both positive were diagnosed.2.Get cost information for POX combined with cardiac auscultation screening(“dual-index” screening)method and cardiac ultrasound examination alone group method separately,and calculate the cost of different screening methods,conduct economic evaluation of the different screening methods and positive detections.Results:Chapter One:1.The A,B and C groups had statistically significant differences in CHD positive detection rate and diagnosis rate(P<0.05),and there were also statistical differences between the pairwise group comparison(P<0.017).2.Through “dual-index” screening,368 cases were positive and 156 cases were diagnosed.The incidence of CHD was 1.51%.PDA ranked first(54 cases),followed by ASD(45 cases),next followed by VSD(38 cases),other CCHD such as COA?TGA?IAA?APVC example were added together,it were 19 cases.3.Results of comparison of the incidence of CHD by sex,birth weight and gestational age:3.1 Different gender had no statistical significance in the incidence of CHD(P>0.05);3.2 Different birth weight was statistically significant in the incidence of CHD(P<0.05),the incidence of CHD in low birth weight was statistically significant compared with normal birth weight and giant weight newborns(P <0.017),there was no difference between normal birth weight and giant weight newborns(P> 0.017);3.3 Different gestational age was statistically significant in the incidence of CHD(P<0.05),the incidence of CHD in premature newborns was statistically significant compared with full-term newborns and overdue newborns(P <0.017),there was no statistical significance between term newborns and overdue newborns(P> 0.017).4.The incidence of CHD in early newborns was 1.97%,and the incidence of CHD at age of 3 months was 1.51%?5.Statistic of high risk factors of 156 pregnant women in early pregnancy :33 cases had no high-risk factors,43 cases had only a single high-risk factor,and the other 80 cases had two or more high-risk factors.Chapter Two:1.A total of 79 cases were diagnosed in the cardiac B-ultrasound examination group,and the incidence of CHD was 1.55%.There were 29 cases of PDA,24 cases of ASD,19 cases of VSD,3 cases of PA,1 case of TGA,and 3 cases of others.2.The cost-effective ratio of the “dual-index” screening group was 1467.85 yuan each case;the cost-effective ratio of cardiac B-ultrasound was 12888.61 yuan each case;the incremental cost-effective ratio of the cardiac B-ultrasound examination compared with the “dual-index” screening strategy was 460703.75 yuan each case.Conclusions:1.The positive diagnosis rate of the “dual-index” screening group was better than other groups.2.The incidence of CHD in Yan'an area was higher than most areas in China.3.There was no difference in the diagnosis rate of CHD between “dual-index”screening and cardiac B-ultrasound examination,And the “dual-index” screening strategy had good health economics advantages.