Aspects of pulse oximetry screening for critical congenital heart defects: when, how and why?

Abstract

Pulse oximetry (PO) screening for critical congenital heart defects (CCHD) has been studied extensively and is being increasingly implemented worldwide. This review provides an overview of all aspects of PO screening that need to be considered when introducing this methodology. PO screening for CCHD is effective, simple, quick, reliable, cost-effective and does not lead to extra burden for parents and caregivers. Test accuracy can be influenced by targets definition, gestational age, timing of screening and antenatal detection of CCHD. Early screening can lead to more false positive screenings, but has the potential to detect significant pathology earlier. There is no apparent difference in accuracy between screening with post-ductal measurements only, compared with screening using pre-ductal and post-ductal measurements. However, adding pre-ductal measurements identifies cases of CCHD which would have been missed by post-ductal screening. Screening at higher altitudes leads to more false positives. Important non-cardiac pathology is found in 35-74% of false positives in large studies. Screening is feasible in neonatal intensive care units and out-of-hospital births. Training caregivers, simplifying the algorithm and using computer-based interpretation tools can improve the quality of the screening. Caregivers need to consider all aspects of screening to enable them to choose an optimal protocol for implementation of CCHD screening in their specific setting.

Maternal acceptability of pulse oximetry screening at home after home birth or very early discharge

“…Pulse oximetry (PO) is an accurate and cost-effective screening tool for critical congenital heart defects (CCHD) in newborns and has the advantage to detect other important neonatal pathology as secondary targets [1, 4, 8, 10]. However, PO screening has not been implemented in the Dutch universal screening program [2].…”

Barriers to the Implementation of Newborn Pulse Oximetry Screening: A Different Perspective

“…When the population of infants with a false positive for CCHD are reviewed in the large data sets of screening, more than 50% of them will have important pathology, including congenital pneumonia, sepsis, meconium aspiration syndrome, milder forms of congenital heart disease, and failure to transition (eg. persistent pulmonary hypertension of the newborn (PPHN), transient tachypnea of the newborn (TTN)) [7,[20][21][22]. Although these studies were not specifically designed to assess the cohort of false positives, a false positive result suggests a 'hypoxic' baby and a baby with undiagnosed Group B streptococcal sepsis, pneumonia, or PPHN is just as likely to collapse and die as a baby with undiagnosed CCHD.…”

Pulse Oximetry Screening for Detection of Critical Congenital Heart Defects: Why to Bother?

“…In recent years, pulse oximetry screening has been recommended by several European countries including Switzerland, Ireland and Poland. The UK national Screening Committee (UK NSC) has recently completed a pilot study on feasibility and implications of pulse oximetry screening [18].…”