BACKGROUND Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods, infants with coarctation may present with life-threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. METHODS AND RESULTS Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children's Healthcare of Atlanta. Patients with coarctation were receiving prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual's upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. CONCLUSIONS We were able to identify specific features in pulse oximetry waveforms that were able to accurately identify patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

中文翻译：

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使用脉搏血氧饱和度波形检测主动脉缩窄。

背景技术主动脉缩窄是严重先天性心脏病的常见形式，在临床恶化之前难以诊断。尽管目前有筛查方法，但缩窄的婴儿可能会出现威胁生命的心源性休克，需要紧急住院和干预。我们试图通过使用一种新型的脉搏血氧饱和度波形分析来改善重症先天性心脏病的筛查，特别是专注于主动脉缩窄的检测。方法和结果在2年的时间里，我们获得了亚特兰大儿童保健中心心脏重症监护病房住院的18例主动脉缩窄的新生儿和18名年龄匹配的对照组的脉搏血氧饱和度波形数据。缩窄的患者正在接受前列腺素E1，动脉导管未闭。通过分析波形中的离散特征，我们确定了有和没有缩窄的患者之间最大跌倒率的统计学差异。当比较上肢和下肢之间的差异时，这一点更加突出，当存在缩窄时，下肢的倾斜角度较小（p值0.001）。术后，修复后的缩窄患者与对照组之间最大跌倒率仍存在差异。但是，与同一个人的上肢和下肢相比，这些差异已正常化。与他们自己（术前和术后）相比，缩窄患者表现出上肢和下肢之间的波形差异，这些差异在成功手术后显着减少（p值0.028）。该筛选算法的检测精度为72％，灵敏度为0.61，特异性为0.94。结论我们能够在脉搏血氧饱和度测定波形中识别出特定特征，从而能够准确识别患有缩窄的患者，并进一步证明这些变化在手术修复后已正常化。因此，可以通过包括波形分析来改善新生儿先天性心脏病的脉搏血氧饱和度筛查，目的是在严重疾病之前识别主动脉缩窄。需要进行进一步的大规模测试，以在新生儿保育场所中发生缩窄风险的患者中验证该筛选模型。结论我们能够在脉搏血氧饱和度测定波形中识别出特定特征，从而能够准确识别患有缩窄的患者，并进一步证明这些改变在手术修复后已正常化。因此，可以通过包括波形分析来改善新生儿先天性心脏病的脉搏血氧饱和度筛查，目的是在严重疾病之前识别主动脉缩窄。需要进行进一步的大规模测试，以在新生儿保育场所中发生缩窄风险的患者中验证该筛选模型。结论我们能够在脉搏血氧饱和度测定波形中识别出特定特征，从而能够准确识别患有缩窄的患者，并进一步证明这些改变在手术修复后已正常化。因此，可以通过包括波形分析来改善新生儿先天性心脏病的脉搏血氧饱和度筛查，目的是在严重疾病之前识别主动脉缩窄。需要进行进一步的大规模测试，以在新生儿保育场所中发生缩窄风险的患者中验证该筛选模型。旨在在严重疾病之前识别主动脉缩窄。需要进行进一步的大规模测试，以在新生儿保育场所中发生缩窄风险的患者中验证该筛选模型。旨在在严重疾病之前识别主动脉缩窄。需要进行进一步的大规模测试，以在新生儿保育场所中发生缩窄风险的患者中验证该筛选模型。