Practical guide for the early diagnosis of critical congenital heart disease by pulse oximetry in Cuba

Abstract

Critical congenital heart disease, if not detected before hemodynamic involvement, leads to high neonatal morbidity and mortality. The incorporation of the technological advances of modern medicine does not reverse this situation. The presentation of this protocol aims to contribute to improving the early and timely detection of these heart diseases in neonates, raising the quality of their care and reducing infant mortality from this cause. Fetal echocardiography diagnosis shows about 80% of heart defects before birth, but several are not easy to detect at this stage. It is in neonatology, with the newborn that is still normal, that the diagnosis of critical cardiovascular problems becomes more important. Digital pulse oximetry, a non-invasive and cost-effective technique, is a useful tool in the suspicion of critical heart disease in a child who does not yet present clinical deterioration. It is used in some countries to measure oxygen saturation in the upper and lower limbs of the neonate without keeping them monitored. This parameter evaluates the degree of peripheral oxygenation and rules out the existence of heart disease, in which it is sometimes difficult to detect clinical cyanosis at that age. The theoretical-pathophysiological bases that justify the use of the protocol for the detection of critical heart disease in neonates are presented, and a diagnostic algorithm of suspicion is proposed that guides specialists and provides them with more elements to early request specialized cardiological assessment and other studies.