525 - Evaluating the Feasibility of Neonatal Pulse Oximetry Screen for Detection of Critical Congenital Heart Disease in Guatemala City

Poster Number: 525
Publication Number: 525.318

Lindsey Gakenheimer-Smith, University of Utah School of Medicine, Salt Lake City, UT, United States; L. Alesandro Larrazabal, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Guillermo Gaitán, Unicar, Guatemala, Mixco, Quiche, Guatemala; Flor Garcia, UNICAR, Guatemala, Sacatepequez, Guatemala; Gonzalo calvimontes, UNICAR, guatemala, Sacatepequez, Guatemala; Guillermo Paz, UNICAR, Guatemala City, Alta Verapaz, Guatemala; Whitnee J. Hogan, University of Utah, Salt Lake City, UT, United States; Nelangi Pinto, University of Utah, Salt Lake City, UT, United States; David F. Teitel, UCSF, San Francisco, CA, United States

Background: Newborn pulse oximetry screening allows for early detection of critical congenital heart disease (CCHD) and is standard of care in many high-income countries. Implementation is scattered in middle income countries, such as Guatemala, where it is not routinely performed. The pediatric cardiac unit of Guatemala (UNICARP) conducted a large-scale newborn pulse oximetry screening program at four hospitals.

Objective: We evaluated this pulse oximetry screening program to inform future screening efforts in Guatemala.

Design/Methods: We retrospectively evaluated pulse oximetry screens performed in term neonates born at one of four tertiary hospitals in Guatemala City from 11/2011 to 3/2017. A persistent oxygen level < 93% in a lower extremity, repeated once within 12 hours, was considered a ‘failed screen’. The 93% cutoff was used to account for Guatemala City’s 1500m elevation. Neonates with failed screens were referred to UNICARP for echocardiograms. We performed descriptive analyses on screening results, follow-up testing, and association of age, sex, and year of screening with screening results.

Results: Pulse oximetry screens were completed on 127,778 term newborns at a median age of 30 hrs (IQR 20, 76). Of these, 0.77% (989) had a failed screen; 41% of failed screens (409) had an echocardiogram. Congenital heart disease was detected in 113, including CCHD in 19. Failed screens were associated with later age (median 31 hrs [IQR 23, 45] vs. 34 hrs [IQR 24, 46] p< 0.001) but not with sex or year of screening. Reasons for not obtaining an echocardiogram were not consistently collected, but a key barrier identified was difficulty arranging transport to the cardiac center for an echocardiogram.Conclusion(s): In the first large newborn pulse oximetry screening program in Guatemala, < 50% of newborns with a failed screen had an echocardiogram. The rate of failed screen was similar to published reports in middle- and high-income countries. However, the proportion who had an echocardiogram and were found to have CCHD were much lower in our study compared to these reports. Identifying and addressing sociodemographic factors limiting access to pulse oximetry screens and pediatric cardiac care in Guatemala are essential to successfully implement neonatal pulse oximetry screening programs in Guatemala.