Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease

Abstract

Our findings indicate that pulse oximetry is a non-invasive and specific screening tool for an early detection of CCVMs, and is easily applicable to a small size nursery.

Role of pulse oximetry in screening of critical congenital heart disease in asymptomatic neonates

“…20,25,28 The positive predictive value of 77.78% was comparable to that obtained by Koppel et al who obtained a PPV of 75%; however, it is higher than that obtained by other workers like Rosati et al, Richmond et al and Hoke et al but less than that obtained by Arlettaz, et al 18,19,21,25,28 The negative predictive value of 99.9% is comparable to all other studies which have reported it to be between 98% to 100%. [18][19][20][21]25,28,29 The false positive rate was to be found to be 0.08% and was comparable to that obtained by Reich, et al, who reported it to be 0.09% at >24 hour. 29 A low false positive rate reduces the number of unnecessary echocardiograms.…”

“…Pulse oximetry has been assessed as a screening method for congenital heart defects in newborn babies in many studies. [18][19][20][21][22][23] Our study was also conducted to evaluate usefulness of pulse oximetry in screening CCHD in asymptomatic newborns.…”

Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and cost-effectiveness.

“…Similarly, using a threshold of < 95% in the foot only -the most frequently used test in previous studies 13,64,[67][68][69]71 -would have reduced the number of FPs by 84, but three critical cases (two Full cohort (n = 20,055, G in Figure 4) 0-6 hours (n = 4956, 25%) …”

“…13 These findings have led to exploration of the possibility that pulse oximetry may be useful in detecting hypoxaemia associated with CHDs in apparently healthy newborns, and a number of studies have been published that have used pulse oximetry as a screen for CHDs in this group. 13,[62][63][64][65][66][67][68][69][70][71] In a systematic review published in 2007, we reviewed the eight published studies available at that time. 72 We highlighted a number of problems when assessing the accuracy of this test as there was a wide variation in methodology, particularly patient selection, timing of saturation measurement, cut-off levels for a positive test result, nature of CHD screened for, rigour of follow-up and type of oximeters used ( Table 2).…”

“…Ascertainment of missed cases (either those dying outside hospital or those presenting to other cardiac units) in order to identify false-negatives (FNs) was complete in only three studies. In general, studies that screened later (24-72 hours) 62,64,65,67,70 had lower FP rates; however, this has to be tempered by the fact that critical CHDs, if undiagnosed, may present with clinical deterioration in the first 48 hours of life; therefore, earlier testing may help to identify these patients before such an event can take place. The increasing trend towards earlier discharge for uncomplicated births also has to be taken into consideration when determining optimal timing.…”