Missed Opportunities for Cardiac Evaluation in Term Newborns With Hypoxemia at KNH-NBU - a Cross-sectional Study

Abstract

Study Background: There are many children with congenital cardiac abnormalities who are either diagnosed late or miss an opportunity to be diagnosed and present their cases when they are too advanced for intervention. Many of these children present to practitioners yet they are not evaluated for congenital heart diseases and this constitutes missed opportunities for cardiac evaluation. Objectives: To determine the proportion of term newborns with hypoxemia at 24 to 48 hours of life who missed further cardiac evaluation within the time of hospital stay. Methodology: A retrospective cross-sectional study was carried out on records of term neonates with low pulse oximetry saturation of <95% at 24hours to 48hours of life and up to the date of discharge at the newborn unit, Kenyatta National Hospital- Kenya. Data Analysis: The data was analysed using R software Version 4.1.2. Descriptive analysis was done on subjects’ demographic data and missed opportunities. Factors associated with missed cardiac evaluation were analysed using odds ratios and a p value of <0.05 was considered significant. The proportion of missed opportunities for cardiac evaluation in term new-borns with hypoxemia was calculated where a 95% cut-off was used as per the Kenyan guidelines (16). Results: A total of 736 term infants were assessed from the CIN database. Out of which206 infants were enrolled in the study. Based on the definition of missed cardiac evaluation, 89.3% (95% CI =84.8 – 92.7) subjects had missed opportunities for cardiac evaluation. Among neonates with missed opportunities (MO) for cardiac evaluation, 67.9% were male and 32.1% were female (X2 = 2.07, p = .1498). The mean duration of hospital stay in days was 8.9 days (SD 15.2) for those who had echocardiogram done (22), TOF with PA was the only cyanotic cardiac lesion identified. Conclusion: The study found 89% proportion of Missed opportunity for cardiac evaluation among term neonates with hypoxemia. There was disproportionately low representation of congenital cardiac abnormalities which are associated with high morbidity and mortality in neonatal period. TOF with PA was the only cyanotic cardiac lesion identified