Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia
Abstract Highland populations suffer from significant infant mortality due to chronic ambient hypoxia, which increases the risk of congenital heart disease (CHD) and neonatal pulmonary hypertension. Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to ide...
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Wiley
2025-08-01
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| Series: | Experimental Physiology |
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| Online Access: | https://doi.org/10.1113/EP092215 |
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| author | Alexandra Heath Inge vonAlvensleben Jesús Ardiles Spielvogel Pablo Freudenthal Johannes Trapp Ivanna Noya Miguel Gálvez Fanny Mendizábal Mariana Gonzales Ceylan Apaza Leibniz Sanga Erin Mc Cann Colleen G. Julian |
| author_facet | Alexandra Heath Inge vonAlvensleben Jesús Ardiles Spielvogel Pablo Freudenthal Johannes Trapp Ivanna Noya Miguel Gálvez Fanny Mendizábal Mariana Gonzales Ceylan Apaza Leibniz Sanga Erin Mc Cann Colleen G. Julian |
| author_sort | Alexandra Heath |
| collection | DOAJ |
| description | Abstract Highland populations suffer from significant infant mortality due to chronic ambient hypoxia, which increases the risk of congenital heart disease (CHD) and neonatal pulmonary hypertension. Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to identify CHD or pulmonary hypertension among neonates born at altitudes >4000 m in Bolivia has been reported. In a study of 1033 newborns in El Alto, Bolivia (4150 m), we determined the prevalence of CHD and prolonged postnatal adaptation. We also tested the accuracy of a neonatal cardiac screening tool in identifying infants with/without these conditions. Finally, diagnoses were contrasted between offspring born to parents of lowland versus highland origin. CHD was found in 54 neonates (5.2%), with the most common diagnoses being patent ductus arteriosus and atrial septal defect. Pulmonary hypertension without CHD was observed in 64 neonates (6.8%), with seven cases of persistent pulmonary hypertension of the newborn (PPHN). The neonatal cardiac screening tool showed a sensitivity of 45% and specificity of 99% for CHD, and 35% sensitivity and 92% specificity for prolonged pulmonary adaptation. Offspring of highland‐origin women tended to have increased CHD risk, while those from lower altitudes were predisposed to prolonged postnatal adaptation and PPHN; paternal altitude of origin had no statistic significance but showed same tendency. The high prevalence of relevant CHD and prolonged pulmonary adaptation in neonates born >4000 m in Bolivia likely contributes to the high infant mortality rates observed. The poor sensitivity of the pilot neonatal cardiac screening instrument underscores the need to develop evidence‐based tools optimized for use in low‐resource, high‐altitude settings. |
| format | Article |
| id | doaj-art-8452d5ab50454945ba3df52ee3bf6aaa |
| institution | DOAJ |
| issn | 0958-0670 1469-445X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Experimental Physiology |
| spelling | doaj-art-8452d5ab50454945ba3df52ee3bf6aaa2025-08-20T02:52:55ZengWileyExperimental Physiology0958-06701469-445X2025-08-0111081060107010.1113/EP092215Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in BoliviaAlexandra Heath0Inge vonAlvensleben1Jesús Ardiles Spielvogel2Pablo Freudenthal3Johannes Trapp4Ivanna Noya5Miguel Gálvez6Fanny Mendizábal7Mariana Gonzales8Ceylan Apaza9Leibniz Sanga10Erin Mc Cann11Colleen G. Julian12Department for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment for Pediatric Cardiology Kardiozentrum La Paz BoliviaDepartment of Mathematics School of Computation, Information and Technology, Technical University of Munich Garching GermanyDepartment for Pediatric Cardiology Hospital ‘Arco Iris’ La Paz BoliviaDepartment of Pediatrics Hospital Municipal Boliviano Holandés El Alto BoliviaDepartment of Pediatrics University of Cincinnati Cincinnati BoliviaDepartment of Pediatrics University of Cincinnatti Cincinnatti USAAbstract Highland populations suffer from significant infant mortality due to chronic ambient hypoxia, which increases the risk of congenital heart disease (CHD) and neonatal pulmonary hypertension. Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to identify CHD or pulmonary hypertension among neonates born at altitudes >4000 m in Bolivia has been reported. In a study of 1033 newborns in El Alto, Bolivia (4150 m), we determined the prevalence of CHD and prolonged postnatal adaptation. We also tested the accuracy of a neonatal cardiac screening tool in identifying infants with/without these conditions. Finally, diagnoses were contrasted between offspring born to parents of lowland versus highland origin. CHD was found in 54 neonates (5.2%), with the most common diagnoses being patent ductus arteriosus and atrial septal defect. Pulmonary hypertension without CHD was observed in 64 neonates (6.8%), with seven cases of persistent pulmonary hypertension of the newborn (PPHN). The neonatal cardiac screening tool showed a sensitivity of 45% and specificity of 99% for CHD, and 35% sensitivity and 92% specificity for prolonged pulmonary adaptation. Offspring of highland‐origin women tended to have increased CHD risk, while those from lower altitudes were predisposed to prolonged postnatal adaptation and PPHN; paternal altitude of origin had no statistic significance but showed same tendency. The high prevalence of relevant CHD and prolonged pulmonary adaptation in neonates born >4000 m in Bolivia likely contributes to the high infant mortality rates observed. The poor sensitivity of the pilot neonatal cardiac screening instrument underscores the need to develop evidence‐based tools optimized for use in low‐resource, high‐altitude settings.https://doi.org/10.1113/EP092215cardiopulmonary transitioncongenital heart diseasehigh altitudehypoxiaoxygen dependencypulmonary hypertension |
| spellingShingle | Alexandra Heath Inge vonAlvensleben Jesús Ardiles Spielvogel Pablo Freudenthal Johannes Trapp Ivanna Noya Miguel Gálvez Fanny Mendizábal Mariana Gonzales Ceylan Apaza Leibniz Sanga Erin Mc Cann Colleen G. Julian Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia Experimental Physiology cardiopulmonary transition congenital heart disease high altitude hypoxia oxygen dependency pulmonary hypertension |
| title | Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia |
| title_full | Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia |
| title_fullStr | Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia |
| title_full_unstemmed | Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia |
| title_short | Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia |
| title_sort | prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in bolivia |
| topic | cardiopulmonary transition congenital heart disease high altitude hypoxia oxygen dependency pulmonary hypertension |
| url | https://doi.org/10.1113/EP092215 |
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