It Is Time for Routine Neonatal Screening by Pulse Oximetry

Abstract

Most pediatric cardiologists believe that pulse oximetry helps to diagnose critical congenital heart disease in neonates who might otherwise be discharged from the newborn nursery undiagnosed. Some of these patients develop catastrophic cardiac and multi-system failure after the ductus closes and die or suffer severe morbidity. Nevertheless, pulse oximetry is not universally used in the newborn nursery. Some pediatricians believe that they can always detect these patients from physical findings, many believe that oximeters are unreliable, and others are concerned about costs of investigating false positive tests. Recent studies, however, show that even cardiologists miss critical congenital heart defects, modern oximeters are stable and reliable, and that the false positive rate is very low, lower than the false positive rate based on physical examination. The benefits probably exceed the cost, and evidence is provided to confirm this. There is no reason not to use pulse oximetry routinely in the newborn nursery.

Non-Surgical Management of Ductal Dependent Lesion as a Safe Option: A Case Report and Review of Literature

“…In that situation, the cardiac output needs to be maintained by keeping the duct open (21). Transient bradycardia and ST elevation while crossing right ventricular outflow tract and moderate pulmonary regurgitation have been noted (22).…”

Congenital Critical Heart Defect Screening in a Health Area of the Community of Valencia (Spain): A Prospective Observational Study

“…In addition, both physical examination of the neonate after birth can further detect congenital cardiac malformations, but not all are found [3,4]. Moreover, low oxygen saturation can also be missed clinically [5,6]. Under these circumstances, pulse oximetry appears to be a reliable screening technique in neonates before hospital discharge.…”

Pulse Oximetry Screening in newborn for early detection of Critical Congenital Heart Disease - A review

“…6,7 Contemporary routine screening for congenital heart disease depends on a mid-trimester anomaly scan, involving imaging of the heart chambers, and a postnatal cardiovascular system examination. 8 The sensitivity of CHD detection by anomaly scan is highly variable, depending on operator expertise, gestational age, fetal position, and the type of cardiac defect. 9 Even when foetal ultrasound is routinely performed, fewer than 50% of cases of CCHD are identified.…”

“…Detection rate by postnatal clinical examination alone is also low leaving up to one-third of babies undiagnosed at the time of discharge with critical heart defects. 8 Echocardio-graphy is an obligatory diagnostic tool but the cost is a severe limitation as a universal screening tool. Moreover, echocardiography has a high frequency of false positive results usually related to the transitional circulation and there may be inadequately trained personnel to perform the test with reasonable accuracy.…”