Why neonatal screening is necessary
As we all know, the incidence of congenital heart disease is about 1%, of which 1/3 is severe congenital heart disease. Severe congenital heart disease includes two categories: one is critical congenital heart disease, which will die if not intervened in the neonatal period; The other is severe congenital heart disease, which will also die if not intervened within 1 year old.
The purpose of neonatal screening is to detect severe congenital heart disease at an early stage. Research in western countries shows that if screening is not carried out, the missed diagnosis rate of neonatal critical congenital heart disease before delivery can reach 30%. Delayed diagnosis led to a neonatal mortality rate of 38.8% and a mortality rate of 50.6% at 3 months, while timely diagnosis reduced the mortality rate to 20% at 3 months.
How to perform neonatal screening
The neonatal congenital heart screening should be completed within 24-48 hours after birth. If it is found that the blood oxygen is low and does not recover within 24 hours after birth (the blood oxygen saturation of normal newborns can reach 85~95% within 10 minutes after birth), the color Doppler echocardiography can be carried out at an early stage to find out whether there is a heart problem as soon as possible, which will help the clinical diagnosis.
Newborn congenital heart disease screening objects: newborns 24-48 hours after birth
Measurement position of neonatal congenital heart screening: right hand or any foot of the measuring object
Newborn congenital heart screening parameters: SpO2 (blood oxygen saturation), PI (blood perfusion index)
Newborn congenital heart screening steps:
Pleth variability index (PVI) is a breakthrough measurement technology, which can help clinicians to evaluate the infusion status of patients noninvasive and continuously, effectively conduct fluid management, evaluate the perfusion status of patients to reflect the patient’s volume level, and monitor the trend and effect of liquid therapy. Under the condition of mechanical ventilation or intubation, the PVI value should be between 9 and 14, and under normal conditions, the PVI value should be between 14 and 25.
MAXIME CANNESSON, associate professor of anesthesiology in the Department of Anesthesiology and Perioperative Nursing at the University of California, Irvine, put forward: “It has been proved that PVI has a high accuracy in distinguishing between those who respond to infusion and those who do not, which is the only opportunity to improve the cardiac function and organ blood flow perfusion level by better managing the infusion volume of patients.”
As shown in the figure, PVI has a similar accuracy (0.94) of pulse pressure changes measured during invasive arterial intubation (0.93 area below the curve), which is higher than the heart index (0.56), central vein pressure (0.42) and pulmonary capillary wedge pressure (0.40).
It is confirmed that according to the definition that the cardiac output increases significantly after infusion management, PVI can help clinicians predict the infusion reaction of patients receiving mechanical oxygen infusion under general anesthesia.
The higher the PVI value, the more likely the patient is to have infusion reaction. The PVI threshold is 14%. If it is greater than 14%, you can take more active steps to replenish albumin or colloidal solution; If the infusion rate is less than 14%, the infusion rate should be slowed down.
PVI can effectively assist doctors in fluid management, evaluate patients’ perfusion status to reflect patients’ capacity level, and monitor the trend and effect of fluid therapy through single site monitoring. It can be observed in cooperation with PI.
——Noninvasive monitoring tool for continuous evaluation of local tissue perfusion and systemic circulation perfusion.
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Masimo SET technology (basic three parameters)
Rainbow SET technology (Rainbow parameter)
With the upgradable rainbow SET platform, you can now choose the appropriate rainbow measurement parameters without worrying about the investment in patients.
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Puritan Bennett of Medtronic 840 Ventilator.
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