May 29, 2024
Aiming to address disparities in neonatal critical congenital heart disease (CCHD) detection and care, a study was conducted to develop new algorithms to detect congenital heart disease (CHD) at different altitudes. Katia Marisa Bravo Jaimes, M.D., an adult congenital cardiologist at Mayo Clinic in Jacksonville, Florida, is the lead author of the study, which was published in the February 2024 issue of the Journal of Perinatology.
Neonatal mortality is a public health problem that disproportionately affects low- and middle-income countries. The causes of neonatal mortality include perinatal asphyxia, sepsis and congenital birth defects. The most common congenital birth defect is CHD, which affects 1 in every 100 newborns.
Neonatal pulse oximetry screening (POS) algorithms for CCHD have helped decrease neonatal mortality but they cannot be applied at high altitudes. New POS algorithms are needed at high altitudes.
Screening highlights
In the recent study, which included more than 500 newborns, Dr. Bravo Jaimes and other cardiac researchers designed two types of CHD screening algorithms. The babies enrolled in the study were born in Peru at different altitudes between sea level and 4,380 meters above sea level. In general, moderate altitude is an elevation over 1,500 meters and high altitude is an elevation greater than 2,500 meters.
"The current algorithms used to detect this problem do not perform well at high altitudes. More than 81.6 million people live above 2,500 meters in the world, and this research helps close the gap in the vulnerable population of babies born at high altitudes," says Dr. Bravo Jaimes. "We developed two types of algorithms that have an excellent negative predictive value of more than 99%. That means if a baby has a negative result, there is 99% chance that the baby does not have CCHD."
The algorithms can be reviewed at the study link below.
- The study included 502 healthy newborns and 15 newborns with CCHD.
- Healthy newborns underwent neonatal preductal and postductal oximetry, echocardiography and telephonic follow-up for 12 months.
- Newborns with CCHD underwent preductal and postductal oximetry at the time of telemedicine evaluation where they were born, and their diagnoses were confirmed with echocardiography.
- The two new types of algorithms were designed using clinically accepted neonatal oximetry cutoffs.
Preventing high-altitude mortality
The findings could impact care by avoiding preventable deaths among babies born at high altitude. "The algorithms detect not only CCHD (which is associated with death in 50% of babies who are detected late) but also neonatal sepsis and pneumonia," says Dr. Bravo Jaimes.
There is a need to focus on a global perspective: "About 500 million people live at altitudes of more than 1,500 meters. A quarter of them are women of reproductive age, who are estimated to deliver 237.5 million newborns in the next decade, of whom 593,750 will have CCHD," says Dr. Bravo Jaimes.
What's next?
An ANDES-CHD AI large dataset study is being done in Peru and will soon expand to Colombia and Bolivia. "Using neonatal electrocardiography, we aim to develop an algorithm that can detect CCHD early and can provide added benefits to pulse oximetry alone," says Dr. Bravo Jaimes.
For more information
Bravo-Jaimes K, et al. A new algorithm detects critical congenital heart disease at different altitudes: ANDES-CHD study. Journal of Perinatology. 2024;44:373.
Refer a patient to Mayo Clinic.