First Day of Life Pulse Oximetry Screening to Detect Congenital Heart Defects

Objective

To evaluate the efficacy of first day of life pulse oximetry screening to detect congenital heart defects (CHDs).

Study design

We performed a population-based prospective multicenter study of postductal (foot) arterial oxygen saturation (SpO₂) in apparently healthy newborns after transfer from the delivery suite to the nursery. SpO₂ < 95% led to further diagnostic evaluations. Of 57,959 live births, 50,008 (86%) were screened. CHDs were prospectively registered and diagnosed in 658 newborns (1.1%), of whom 35 (5%) were classified as critical (ductus dependent, cyanotic).

Results

Of the infants screened, 324 (0.6%) failed the test. Of these, 43 (13%) had CHDs (27 critical), and 134 (41%) had pulmonary diseases or other disorders. The remaining 147 infants (45%) were healthy with transitional circulation. The median age for babies with CHDs at failing the test was 6 hours (range, 1-21 hours). For identifying critical CHDs, the pulse oximetry screening had a sensitivity rate of 77.1% (95% CI, 59.4-89.0), specificity rate of 99.4% (95% CI, 99.3-99.5), and a false-positive rate of 0.6% (95% CI, 0.5-0.7).

Conclusions

Early pulse oximetry screening promotes early detection of critical CHDs and other potentially severe diseases. The sensitivity rate for detecting critical CHDs is high, and the false-positive rate is low.

Abbreviations: CHD, Congenital heart defect, SpO₂, Arterial oxygen saturation