One of the consequences of short hospital stays for newborn infants is the possibility of missing a diagnosis of late-onset sepsis, metabolic disorders, or congenital heart disease (CHD). Many affected infants will be brought to the hospital for life-saving treatment, but for others, it will be too late and they will die before treatment can be instituted.

To evaluate the rate of missed diagnosis of CHD, investigators reviewed the records of 898 infants who died of CHD over a 5-year period. This group included 152 infants with missed or delayed diagnosis of CHD who died at a median age of 13.5 days. More than half of these infants died at home or in the emergency department. The most common diagnoses were hypoplastic left heart syndrome and coarctation of the aorta. Every year, 30 infants (10 missed and 20 delayed) die of a missed or late diagnosis of CHD.

To prevent this tragic outcome, primary care providers should carefully assess cardiovascular function in all newborns, seeking evidence suggesting left heart obstructive CHD. This examination should take place during the first postdischarge visit at 3 to 5 days of age.1 It has been suggested in the past that screening with pulse oximetry at 4 hours of age is useful in identifying infants with CHD, but recent evidence suggests that this practice offers no advantage over clinical observation and assessment.2

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