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 (SpO 2) in apparently healthy newborns after transfer from the delivery suite to the nursery. SpO 2 < 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)
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      References

        • Wren C.
        • Richmond S.
        • Donaldson L.
        Presentation of congenital heart disease in infancy: implications for routine examination.
        Arch Dis Child Fetal Neonatal Ed. 1999; 80: F49-F53
        • Meberg A.
        • Otterstad J.E.
        • Frøland G.
        • Hals J.
        • Sørland S.J.
        Early clinical screening of neonates for congenital heart defects: the cases we miss.
        Cardiol Young. 1999; 9: 169-174
        • Mellander M.
        • Sunnegårdh J.
        Failure to diagnose critical heart malformations in newborns before discharge—an increasing problem?.
        Acta Paediatr. 2006; 95: 407-413
        • Reinhard Z.
        • Wren C.
        Twenty year trends in recognition of life-threathening neonatal cardiac malformations.
        Cardiol Young. 2006; 16: 312
        • Richmond S.
        • Reay G.
        • Abu Harb M.
        Routine pulse oximetry in the asymptomatic newborn.
        Arch Dis Child Fetal Neonatal Ed. 2002; 87: F83-F88
        • Hoke T.R.
        • Donohue P.K.
        • Bawa P.K.
        • Mitchell R.D.
        • Pathak A.
        • Rowe P.C.
        • Burne B.J.
        Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study.
        Pediatr Cardiol. 2002; 23: 403-409
        • Koppel R.I.
        • Druschel C.M.
        • Carter T.
        • Goldberg B.E.
        • Metha P.N.
        • Talwar R.
        • et al.
        Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns.
        Pediatrics. 2003; 111: 451-455
        • Reich J.D.
        • Miller S.
        • Brogdon B.
        • Casatelli J.
        • Gomph T.C.
        • Huhta J.C.
        • et al.
        The use of pulse oximetry to detect congenital heart disease.
        J Pediatr. 2003; 142: 268-272
        • Bakr A.F.
        • Habib H.S.
        Combining pulse oximetry and clinical examination in screening for congenital heart disease.
        Pediatr Cardiol. 2005; 26: 832-835
        • Rosati E.
        • Chitano G.
        • Dipaola L.
        • De Felice C.
        • Latini G.
        Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease.
        J Pediatr. 2005; 33: 455-457
        • Arlettaz R.
        • Bauschatz A.S.
        • Mönkhoff M.
        • Essers B.
        • Bauersfeld U.
        The contribution of pulse oximetry to the early detection of congenital heart disease in newborns.
        Eur J Pediatr. 2006; 165: 94-98
        • Pass K.A.
        Not as pink as you think!.
        Pediatrics. 2003; 111: 670-671
        • Hannon D.W.
        Relief for the (missed) blue babies.
        J Pediatr. 2003; 142: 231-233
        • Valmari P.
        Should pulse oximetry be used to screen for congenital heart disease?.
        Arch Dis Child Fetal Neonatal Ed. 2007; 92: 219-224
        • Thangaratinam S.
        • Daniels J.
        • Ewer A.K.
        • Zamora J.
        • Khan K.S.
        Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review.
        Arch Dis Child Fetal Neonatal Ed. 2007; 92: 176-180
        • Aamir T.
        • Kruse L.
        • Ezeakudo O.
        Delayed diagnosis of critical congenital cardiovascular malformations (CCVM) and pulse oximetry screening of newborns.
        Acta Paediatrica. 2007; 96: 1146-1149
        • Kopotic R.J.
        • Lindner W.
        Assessing high-risk infants in the delivery room with pulse oximetry.
        Anesth Analg. 2002; 94: S31-S36
        • Abu-Harb M.
        • Hey E.
        • Wren C.
        Death in infancy from unrecognized congenital heart disease.
        Arch Dis Child. 1994; 71: 3-7
        • Tegnander E.
        • Williams W.
        • Johansen O.J.
        • Blass H.-G.K.
        • Eik-Nes S.
        Prenatal detction of heart defects in a non-selected population of 30,149 fetuses—detection rates and outcome.
        Ultrasound Obstet Gynecol. 2006; 27: 252-265
        • Westin M.
        • Saltvedt S.
        • Bergman G.
        • Kublickas M.
        • Alström H.
        • Grunewald C.
        • et al.
        Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations?.
        BJOG. 2006; 113: 675-682
        • Dawes G.S.
        Foetal and neonatal physiology.
        Year Book Medical Publishers, Chicago1968
      1. Meberg A, Brun C. Pulse oximetry screening for congenital heart defects in newborn infants. XIX Nordic Congress of Perinatal Medicine, Lund, Sweden, May 19-21, 2005 (abstract).

        • Toth B.
        • Becker A.
        • Seelbach-Göbel B.
        Oxygen saturation in healthy newborn infants immediately after birth measured by pulse oximetry.
        Arch Gynecol Obstet. 2002; 266: 105-107
        • Kamlin C.O.F.
        • O'Donnell C.P.F.
        • Davis P.G.
        • Morley C.J.
        Oxygen saturation in healthy infants immediately after birth.
        J Pediatr. 2006; 148: 585-589
        • Rabi Y.
        • Yee W.
        • Chen S.Y.
        • Singhal N.
        Oxygen saturation trends immediately after birth.
        J Pediatr. 2006; 148: 590-594
        • De-Wahl Granelli A.
        • Mellander M.
        • Sunnegårdh J.
        • Sandberg K.
        • Östman-Smith I.
        Screening for duct-dependent congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity.
        Acta Paediatr. 2005; 94: 1590-1596

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