Cardiovascular Malformations

[Cardiovascular Malformations]

by

Acknowledgement

I would take this opportunity to express gratitude my research supervisor, family and associates for their support and guidance without which this study would not have been possible.

DECLARATION

I,[……], declare that the contents of this dissertation/thesis comprise my own unaided work, and that the dissertation/thesis has not previously been submitted for academic written test in the direction of any qualification. Furthermore, it comprises my own attitudes and not inevitably those of the University.

Signed __________________ Date _________________

CHAPTER 1: INTRODUCTION

Cardiovascular malformations are the commonest kind of congenital malformation, but a sizeable percentage is not noticed by usual neonatal examination. Cardiovascular malformations account for 6-10% of all infant killings and 20-40% of killings initiated by congenital malformation. About 1-1.8 babies per 1000 live births have a duct reliant circulation, with a persistent ductus arteriosus being necessary for survival. These babies are at particular risk from the worldwide tendency towards early discharge from maternity units, as the effects of ductal closure may not be apparent at an early discharge examination. Some 10-30% of babies who pass away from congenital heart disease manage not have their status diagnosed before autopsy. In London over the past decade increasing proportions of babies with critical congenital heart disease have been leaving hospital with their status undiagnosed.

 

CHAPTER 3: METHODOLOGY

We carried out a systematic reconsider with a prospective protocol using broadly suggested Methods.

  

Study Assortment and Facts and Figures Extraction

Studies which assessed the accuracy of pulse oximetry in asymptomatic newborns for the detection of congenital heart disease were selected by a two-stage process. First, the electrical devices searches were scrutinised and full manuscripts of all citations that were probable to rendezvous the predefined selection criteria were obtained by two unaligned reviewers (ST and JD). Second, final addition or exclusion conclusions were made by the reviewers (ST and JD) after examination of these manuscripts. Studies which contacted the predefined and explicit criteria regarding population, tests, outcomes and study design were selected for the reconsider (see appendix 1, available at http://adc.bmj.com/supplemental). Where disagreements appeared, they were resolved by consensus. In cases of duplicate publications, the most latest or entire versions were selected. (Kleijnen, 2006, 6)

From each selected article, we extracted information on the study population which encompassed age, test characteristics along with frequency and procedure of testing, and methodological quality, encompassing verification of diagnosis of congenital heart disease by echocardiography. Accuracy data were used to construct 2x2 tables of pulse oximetry results (test positive if pulse oximetry values were underneath a threshold as characterised in the primary study, and test negative if these were above the threshold) and presence or absence of congenital heart disease diagnosed by echocardiography (wherever employed). Where accuracy data were not extractable, we contacted the corresponding author by note or email to seek his or her assistance in data extraction.

 

Assessment of Methodological Quality

All manuscripts gathering the selection criteria were assessed for their methodological quality. Quality was characterised as the self-assurance that the study design, perform and analysis minimised assessment bias in the estimation of test ...