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Improving diagnostic accuracy in neonates with left heart obstruction in a transport setting
Author(s) -
Boyd Stephanie M,
Staub Eveline,
Browning Carmo Kathryn
Publication year - 2021
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.15102
Subject(s) - medicine , retrospective cohort study , confidence interval , odds ratio , logistic regression , pediatrics
Aim Differentiating left heart obstruction (LHO) from other severe illness in the neonatal period is challenging, and important for guiding clinical management. The aim of this study was to identify factors distinguishing LHO from non‐LHO in neonates. Methods A retrospective, cohort study of neonates referred to the Newborn and Paediatric Emergency Transport Service, New South Wales, with suspected LHO during the epoch 1996–2016. Results A total of 273 neonates were included; 240 with confirmed LHO. Administration of prostaglandin E 1 to infants with a structurally normal heart was not associated with impaired acid–base or oxygenation status. Pre‐transport diagnostic accuracy of LHO was 74.4%; sensitivity 84.5%, positive predictive value 86.0%. On multivariable logistic regression, hepatomegaly (odds ratio 2.54; 95% confidence interval 1.05–6.16) was associated with confirmed LHO. Conclusions A low threshold for prostaglandin E 1 infusion should be maintained in infants with suspected LHO. Hepatomegaly is associated with a diagnosis of LHO and may be more useful than other parameters in predicting the condition.