Izhar et al reported a protocol for screening an infant for congenital heart disease. This can help to identify an infant who should undergo an echocardiography exam. The authors are from Aligarh Muslim University in India.
Patient selection: infant, negative for heart disease on neonatal screen
Parameters from history:
(1) bluish discoloration
(2) difficulty feeding
(3) difficulty breathing
(4) precordial activity or pulsations
(5) failure to thrive
(6) cyanotic spells
(7) history of consanguinity
(8) family history of congenital heart disease
Parameters from clinical exam:
(9) clinical stigmata of a specific syndrome
(10) pulse volume
(11) discrepancy in blood pressure
(12) SpO2 by pulse oximetry
(13) hepatomegaly
(14) precordium examination
(15) heart sounds on auscultation
(16) murmur
|
Parameter |
Findings |
Points |
|
bluish discoloration |
no |
0 |
|
|
yes |
2 |
|
difficulty feeding |
no |
0 |
|
|
yes |
1 |
|
difficulty breathing |
no |
0 |
|
|
yes |
1 |
|
precordial activity |
normal |
0 |
|
|
increased; pulsations |
1 |
|
failure to thrive |
no |
0 |
|
|
yes |
1 |
|
cyanotic spells |
no |
0 |
|
|
yes |
2 |
|
history of consanguinity |
no |
0 |
|
|
yes |
1 |
|
family history of congenital heart disease |
no |
0 |
|
|
yes |
1 |
|
clinical stigmata of specific syndrome |
no |
0 |
|
|
yes |
1 |
|
pulse volume |
normal |
0 |
|
|
decreased; any discrepancy |
1 |
|
discrepancy in blood pressure |
no |
0 |
|
|
yes |
1 |
|
SpO2 by pulse oximetry |
>= 95% |
0 |
|
|
< 95% |
2 |
|
hepatomegaly |
no |
0 |
|
|
yes |
1 |
|
precordium exam |
normal |
0 |
|
|
abnormal |
1 |
|
heart sounds |
normal |
0 |
|
|
abnormal |
1 |
|
murmur |
absent |
0 |
|
|
present |
2 |
where:
• The distinction between bluish discoloration and cyanotic spells is unclear.
• Abnormal precordial exam: visible precordial pulsations, abnormal position or character of apex beat, presence of a thrill.
total score =
= SUM(points for all 16 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• Echocardiography was performed if the screen was considered positive (>= 3).
|
Total Score |
Congenital Heart Disease |
|
0 or 1 |
0% |
|
2 |
16% |
|
3 |
33% |
|
4 |
71% |
|
>= 5 |
100% |
Performance:
• The sensitivity was 97% and specificity 99% using a cutoff >= 3.
Specialty: Cardiology
