15: Supporting the Need for Newborn Pulse Oximetry Screening
Bibliographic record
Abstract
Approximately 1/100 children are born with congenital heart disease (CHD) yearly. Delayed diagnosis of a critical subset of CHD that are cyanotic or require surgery within the first weeks of life increases morbidity and mortality. Pulse oximetry screening has improved detection of critical CHD otherwise undiagnosed by prenatal ultrasound and newborn examination. The AAP endorsed a screening protocol that requires oxygen saturation checks in all neonates prior to discharge and a saturation of <95% triggers further evaluation. We sought to quantify the number of neonates that would have benefited from pulse oximetry screening in our region, to support the need for a screening protocol. Medical records of all neonates with critical CHD who required surgery within six months of life were reviewed from April 2008 to April 2013, with REB approval. A total of 115 neonates from four regions required surgery for critical CHD, of whom 70 (61%) had surgery within the first two weeks of life. Fifty-six (49%) were not identified prenatally, with notable differences in detection rates between regions. Fifteen of 56 (27%) were not diagnosed prior to newborn discharge (eight coarctations, two total anomalous pulmonary venous connections, two transpositions, one interrupted arch, one pulmonary atresia, and one double inlet left ventricle). Twelve of 15 (80%) of these late diagnoses had saturations <95% at re-presentation with CHD (this increases to 100% excluding the coarctation group, who are not necessarily cyanotic at birth). Among the 15 late diagnoses, the most common findings in addition to cyanosis were murmurs (80%), tachypnea (47%), weak femoral pulses (47%) and increased work of breathing (33%). Forty-one of 56 (73%) without prenatal diagnosis were detected prior to discharge (11 transpositions, 11 coarctations, six hypoplastic left hearts, five total anomalous pulmonary venous connections, three pulmonary atresias, two truncus arteriosus, one tetralogy of Fallot, one double inlet left ventricle, one interrupted arch). The most common signs in this group were cyanosis (69%), murmurs (55%), weak femoral pulses (33%), and tachypnea (31%). Seven of 41 (17%) showed only cyanosis. Among these 41, 25 (61%) were detected within 24 h, four (10%) between 24 h and 48 h, and 12 (29%) >48 h of age. This study reaffirms the limitations to prenatal ultrasound and newborn examination in detecting critical CHD. It is likely that the 15 late diagnoses we identified could have been detected with pulse oximetry screening prior to discharge, equating to two to three patients each year that screening may help to detect in our region.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.035 | 0.151 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.011 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".