Abstract
Introduction. Prenatal diagnosis and postnatal pulse oximetry test have low sensitivity and specificity in pathology of the aortic arch, especially isolated. The clinical examination of the newborn remains the leading one in the diagnosis of critical aortic malformation before the development of cardiogenic shock.
Objective. To optimize the diagnosis of aortic arch pathology in newborns and the routing of such patients.
Material and methods. A retrospective analysis of the medical histories of all 499 newborns who were initially admitted with coarctation of the aorta (CoAo) from 2004 to 2015 was performed.
Results. Prenatal aortic pathology was suspected in 34% of children. The first clinical symptoms, according to the anamnesis, were: tachypnea (77%), pallor (73%), heart murmur (62%), decreased appetite in 60%. At the time of admission to the cardiosurgical hospital, a decrease in femoral artery pulsation was observed in 75% of children, and the difference in systolic blood pressure between the limbs was 40 [20–70] mm Hg; SpO2 on the hands of 92 [90–95]% with a difference between the limbs of 7 [4–11]%. Analyzing the literature data and the results we obtained, we developed an algorithm of actions based on the use of the neonatologist for daily examination of newborns of the scale of evaluation of clinical manifestations, containing 9 signs. If they are available, the child is assigned points, the amount of which determines the algorithm for further actions.
Conclusions. Attention to early clinical signs, which are the basis of the scale developed by us, will allow not only to suspect CoAo, but also to send the child to a specialized institution in a timely manner. The proposed algorithm is quite simple in execution and, in our opinion, can be used in medical institutions of various levels.
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About the authors
- Elena G. Levchenko, Dr. Med. Sc., Leading Researcher, Pediatric Cardiologist,
ORCID
- Andrey A. Svobodov, Dr. Med. Sc., Deputy Director, Cardiac Surgeon, ORCID
- Margarita R. Tumanyan, Dr. Med. Sc., Head of Department, ORCID
- Aleksey G. Anderson, Cand. Med. Sc., Leading Researcher, Pediatric Cardiologist, ORCID
