Evaluation of Neonates With Suspected Congenital Heart Disease: A New Cost-Effective Algorithm

Prashant Minocha, Arpit Agarwal, Nurin Jivani, Sethuraman Swaminathan

Research output: Contribution to journalArticle

Abstract

We assessed the value of existing guidelines for the evaluation of suspected congenital heart disease (CHD) in term neonates and propose a revised algorithm. Retrospective chart review of newborns referred for cardiac evaluation at a tertiary care center was performed. A total of 777 newborns qualified for the study. Among these, 3 critical and 8 major CHD were identified. The sensitivity of the combination of abnormal physical examination and pulse oximetry screening for major and critical CHD was 100%. The cost to detect a case of critical CHD, based on echocardiograms done for all abnormal electrocardiograms, was 3.4 times more than that incurred for performing this test on the basis of abnormal pulse oximetry and physical examination. Adding electrocardiogram to CHD screening increases cost without adding diagnostic yield. Based on our findings, we propose a revised algorithm for a systematic cost-effective approach to cardiac evaluation of term newborns with suspected CHD.
Original languageEnglish (US)
JournalClinical Pediatrics
DOIs
StatePublished - Aug 2018

Fingerprint

Heart Diseases
Costs and Cost Analysis
Oximetry
Physical Examination
Electrocardiography
Tertiary Care Centers
Guidelines

Keywords

  • congenital heart disease; cost-effectiveness; echocardiogram; newborns; screening guidelines

Cite this

Evaluation of Neonates With Suspected Congenital Heart Disease: A New Cost-Effective Algorithm. / Minocha, Prashant; Agarwal, Arpit; Jivani, Nurin; Swaminathan, Sethuraman.

In: Clinical Pediatrics, 08.2018.

Research output: Contribution to journalArticle

@article{29b811cfce104fd086cbf458a9c50f3d,
title = "Evaluation of Neonates With Suspected Congenital Heart Disease: A New Cost-Effective Algorithm",
abstract = "We assessed the value of existing guidelines for the evaluation of suspected congenital heart disease (CHD) in term neonates and propose a revised algorithm. Retrospective chart review of newborns referred for cardiac evaluation at a tertiary care center was performed. A total of 777 newborns qualified for the study. Among these, 3 critical and 8 major CHD were identified. The sensitivity of the combination of abnormal physical examination and pulse oximetry screening for major and critical CHD was 100{\%}. The cost to detect a case of critical CHD, based on echocardiograms done for all abnormal electrocardiograms, was 3.4 times more than that incurred for performing this test on the basis of abnormal pulse oximetry and physical examination. Adding electrocardiogram to CHD screening increases cost without adding diagnostic yield. Based on our findings, we propose a revised algorithm for a systematic cost-effective approach to cardiac evaluation of term newborns with suspected CHD.",
keywords = "congenital heart disease; cost-effectiveness; echocardiogram; newborns; screening guidelines",
author = "Prashant Minocha and Arpit Agarwal and Nurin Jivani and Sethuraman Swaminathan",
year = "2018",
month = "8",
doi = "10.1177/0009922818793341",
language = "English (US)",
journal = "Clinical Pediatrics",
issn = "0009-9228",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - Evaluation of Neonates With Suspected Congenital Heart Disease: A New Cost-Effective Algorithm

AU - Minocha, Prashant

AU - Agarwal, Arpit

AU - Jivani, Nurin

AU - Swaminathan, Sethuraman

PY - 2018/8

Y1 - 2018/8

N2 - We assessed the value of existing guidelines for the evaluation of suspected congenital heart disease (CHD) in term neonates and propose a revised algorithm. Retrospective chart review of newborns referred for cardiac evaluation at a tertiary care center was performed. A total of 777 newborns qualified for the study. Among these, 3 critical and 8 major CHD were identified. The sensitivity of the combination of abnormal physical examination and pulse oximetry screening for major and critical CHD was 100%. The cost to detect a case of critical CHD, based on echocardiograms done for all abnormal electrocardiograms, was 3.4 times more than that incurred for performing this test on the basis of abnormal pulse oximetry and physical examination. Adding electrocardiogram to CHD screening increases cost without adding diagnostic yield. Based on our findings, we propose a revised algorithm for a systematic cost-effective approach to cardiac evaluation of term newborns with suspected CHD.

AB - We assessed the value of existing guidelines for the evaluation of suspected congenital heart disease (CHD) in term neonates and propose a revised algorithm. Retrospective chart review of newborns referred for cardiac evaluation at a tertiary care center was performed. A total of 777 newborns qualified for the study. Among these, 3 critical and 8 major CHD were identified. The sensitivity of the combination of abnormal physical examination and pulse oximetry screening for major and critical CHD was 100%. The cost to detect a case of critical CHD, based on echocardiograms done for all abnormal electrocardiograms, was 3.4 times more than that incurred for performing this test on the basis of abnormal pulse oximetry and physical examination. Adding electrocardiogram to CHD screening increases cost without adding diagnostic yield. Based on our findings, we propose a revised algorithm for a systematic cost-effective approach to cardiac evaluation of term newborns with suspected CHD.

KW - congenital heart disease; cost-effectiveness; echocardiogram; newborns; screening guidelines

U2 - 10.1177/0009922818793341

DO - 10.1177/0009922818793341

M3 - Article

JO - Clinical Pediatrics

JF - Clinical Pediatrics

SN - 0009-9228

ER -