This study aimed to report the progress and results of the newborn screening program for congenital heart disease (CHD) in south Shanghai between 2019 and 2023, and to evaluate the accuracy of the dual-index method (pulse oximetry (POX) plus cardiac murmur auscultation) in clinical practice. Between 2019 and 2023, a total of 198,606 (99.89%) newborns were screened for CHD, of whom 3299 (1.66%) tested positive, 3043 (92.24%) underwent echocardiography for CHD diagnosis and 1109 were diagnosed with CHD in a timely manner. Among 195,307 infants with negative screening results using the dual-index method, 139 (0.07%) were later diagnosed with CHD, and none of these infants died. More than half of these false-negative infants (59.39%) were identified due to the detection of a heart murmur during routine physical examinations within six months after birth. Compared to POX testing alone, the dual-index method significantly improved the sensitivity of screening for CHD, and kept high specificity in clinical practice. This study demonstrated that newborn screening for CHD has been well conducted in Shanghai, and the dual-index method had high accuracy and reliability for neonatal CHD screening in clinical practice.

Background: Unintentional poisoning occurs at all ages and races, and remains one of the leading causes of unintentional injury-related fatalities in the USA. However, more recent and comprehensive population-based unintentional poisoning mortality data are lacking in the USA. This study aimed to comprehensively assess trends in USA mortality due to unintentional poisoning from 1999 to 2020, and identify specific causes of death underlying the temporal trends. Methods: We conducted an analysis of death certificates from 1999 to 2020 to calculate annual mortality due to unintentional poisoning by age, sex, race, census region, state, and cause of death. Joinpoint regression was used to evaluate temporal trends in mortality due to unintentional poisoning. Results: There were 813 390 deaths due to unintentional poisoning during 1999–2020. Adults aged 35–49 years, males, American Indian or Alaska Native, and residents of the Northeast had the highest mortality due to unintentional poisoning. The period from 1999 to 2020 witnessed a more than five-fold increase in the age-adjusted mortality rate due to unintentional poisoning from 4.37 to 26.95 per 100 000 people (average annual percent change = 8.96%, 95% confidence interval: 6.92%–11.04%), with rapidly increasing trends for all ages, sexes, races, regions and states. The increasing trends are particularly concerning among adults aged 50–64 years, females, White, and residents of the Midwest. Additionally, we demonstrated that drug poisoning, especially poisoning by narcotics and psychodysleptics, was the leading cause of death from unintentional poisoning, and mortality due to unintentional poisoning by psychotherapeutic drugs had the most rapid rate of increase. Conclusions: USA mortality due to unintentional poisoning increased rapidly from 1999 to 2020 for all ages, sexes, races, census regions, and states. The rapid increase in mortality due to unintentional poisonings is a national emergency, and drug policy measures such as enhancing prescription drug monitoring, restricting the availability of illicit synthetic opioids, and increasing law enforcement efforts are needed to avert further premature deaths and address health disparities.

The peripheral perfusion index (PPI) is a non-invasive indicator of peripheral tissue perfusion in neonates. However, reference values for the PPI at different postnatal time points in healthy neonates residing at high altitudes, as well as early perfusion characteristics in infants with congenital heart disease (CHD) in these settings, remain inadequately defined. The primary aim was to determine the dynamic changes in and percentile-based reference values of the PPI in healthy neonates during the first 6–72 h after birth in the high-altitude region of Tibet. A secondary, exploratory aim was to observe PPI patterns in neonates with CHD born during the same period and to compare the two groups, given the limited number of CHD cases enrolled. A longitudinal cohort study was conducted among consecutively born neonates in a high-altitude region of Tibet. The PPI was measured in the right hand (pre-ductal) and either foot (post-ductal) at 6, ~12, ~24, ~48, and ~72 h after birth. Generalized Additive Models for Location, Scale and Shape (GAMLSS) were used to construct percentile reference curves for healthy neonates. Generalized Estimating Equations (GEE) were applied to evaluate differences in the PPI across time points, measurement sites, and between groups (healthy vs. CHD). A total of 1043 neonates were enrolled, including 1034 in the healthy group and only 9 CHD cases. In healthy neonates, the PPI increased progressively within the first 72 h, with a rapid rise from 6 to 24 h, a slower increase from 24 to 48 h, and stabilization between 48 and 72 h. At all time points, the lower-limb PPI was significantly higher than the upper-limb PPI (p < 0.001). The 50th percentile (P₅₀) values for the upper-limb PPI at 6, 12, 24, 48, and 72 h were 2.32, 2.46, 2.62, 2.63, and 2.77, respectively; corresponding values for the lower-limb PPI were 2.53, 2.64, 2.76, 2.77, and 2.90. Compared to the healthy group, neonates with CHD at high altitudes had similar PPI at 6 h. However, their PPI was significantly lower between 12 and 48 h. At 72 h, no statistically significant difference was found between the groups, likely due to the small sample size of CHD infants. Conclusions: This study provides a reference for routine perfusion assessment in stable neonates born at high altitudes. Due to the limited sample size (only 9 CHD cases), our findings on PPI changes in neonates with CHD remain preliminary. The normative PPI percentile curves established in this study offer objective baseline perfusion data for stable neonates living in high-altitude areas. Future large-scale cohort studies are still needed to validate the clinical value of the PPI as a perfusion monitoring tool in infants with CHD.