Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

Abstract

Background: Critical congenital heart disease (CCHD) constitutes a spectrum of different heart anomalies needing intervention early in life for survival. Pulse oximetry screening (POS) claims to have a sensitivity of 60%, specificity of 99.95%, positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 99.98% in detecting CCHD.Objectives: To assess the effectiveness of POS in identifying CCHD in a tertiary care neonatal unit in Sri Lanka.Method: A prospective descriptive study was carried out at Sri Jayewardenepura General Hospital (SJGH) from October 2017 to March 2020 including all healthy newborns delivered at SJGH. Babies with a prenatal diagnosis of CHD and those who needed admission to neonatal unit before POS was performed were excluded. Recruited babies underwent POS after 24 hours, but before 48 hours of life, in addition to routine newborn examination.Results: There were 8964 live births during the study period. POS was carried out in 8718 babies and was positive in 19 babies; 18 babies had CHD confirmed by echocardiogram, out of which 14 had CCHD. Hence, the incidence of CCHD, identified by POS was 1.56 per 1000 live births. Furthermore, POS demonstrated a PPV of 73.7%, and a false positive rate of 0.06%.

Incidence and Predictors of Mortality among Neonates Admitted for Congenital Heart Disease in Public Comprehensives Specialized Hospitals, Amhara Region, Ethiopia 2023

“…Incidence of mortality among neonates with congenital heart disease was 11.9 (95% CI; -0.009-0.015) per 1000 persons of observation which was in line with a study conducted, USA neonatal mortality (0.37/1000%) [48], in gingdao china (9.38/1000%), [49],south china was approximately 11.1 per 1,000 live births [50] and Sri lanka 1.56/1000 live birth [51], The possible reason could be due to the study were conducted at the hospital level, in which different complicated neonatal cases can be referred from different corners of the region, so due to a high number of complicated cases the mortality could be increased.…”

Feasibility of screening for critical congenital heart disease using pulse oximetry in Indonesia

“…The prevalence of CCHD in our study was 6 of 1000 live births, with positive CCHD screens occurring in 8/1452 (0.6%) of newborns. This was higher than previously reported in Sri Lanka 0.16% (14/8718), [ 13 ], India 0.16% (3/1855) [ 12 ], Turkey 0.12% (12/10,200) [ 18 ], Morocco 0.06% (5/8013) [ 19 ], the Netherlands 0.02% (5/23,959) [ 20 ], New Zealand 0.02% (3/16,644) [ 21 ], South Africa 0.01% (1/1001) [ 11 ] and the United States (US) 0.01% (1/6745) [ 16 ].…”

“…Furthermore, unnecessary costs related to complications due to late diagnosis of CCHD can be avoided [ 10 ]. Studies on the feasibility of pulse oximetry screening to detect CCHD have been conducted in low- and middle-income country setting including South Africa [ 11 ], India [ 12 ], Sri Lanka [ 13 ] and Brazil [ 14 ]. Despite the importance shown in the immediate detection of CCHD, no screening program has been implemented in Indonesia, contributing to the often presentation of late and even terminal cases at tertiary hospitals.…”

Pulse oximetry test for screening congenital heart diseases: a systematic review

“…Subsequently, subgroup analyses were carried out for sensitivity and specificity, according to the time of birth and the first POT measurement between 24 and 48 hours (Figures S1 and S2). In this meta-analysis, 20 studies were included (21)(22)(23)(24)27,28,(31)(32)(33)(35)(36)(37)(38)(40)(41)(42)(44)(45)(46)(47)(48) with a sample of 203,992 participants. An increase in sensitivity to 67% (95% CI: 62% to 72%) and specificity to 97% (95% CI: 97% to 97) was demonstrated.…”

“…A third analysis including studies that were carried out with protocols that contained retests after the first measurement, comprising 13 studies (21,24,27,28,31,32,34,35,37,38,42,44,45) and a sample of 124,469 participants was also developed (Figures S3 and S4). In this analysis, there was a similar increase in sensitivity to 91% (95% CI: 85% to 95%) and specificity to 100% (95% CI: 100% to 100%).…”