Large scale application of pulse oximeter and auscultation in screening of neonatal congenital heart disease

Abstract

Purpose To conduct a retrospective evaluation of a large clinical implementation of combined pulse oximeter (POX) and cardiac auscultation as a fast-screening device for congenital heart disease (CHD). Methods Every newborn in a large maternity healthcare center received auscultation and POX screening within 24 hours after delivery. When an abnormal heart murmur or SpO2 level was detected, an echocardiogram was ordered to confirm the diagnosis of CHD. Results From January 1, 2018 to December 31, 2019, there were 44,147 livebirths at the studied hospital where 498 suspected CHD were identified: 27 newborns by POX screening and 471 by cardiac auscultation. The diagnosis was further confirmed in 458 neonates through echocardiogram. This result put forth an overall diagnosis rate of 92.0%. Cardiac auscultation detected the majority of CHD cases 438 (95.6%) while POX only screened 20 (4.4%) cases. Interestingly, no CHD case was detected by both auscultation examination and POX screening. Auscultation detected most of the common types of CHD, but POX excelled in identifying rare and critical cases. POX screening alone had a very low accuracy of 74.07% in positive predict value (PPV). On the other hand, auscultation functioned well in terms of PPV and negative predict value (NPV) (92.99 and 99.95%, respectively), but the addition of POX improved the overall screening performance resulting in 100% NPV. We also validate the finding with the data 6 months after the study period. Conclusion Our study demonstrated that addition of pulse oximetry to routine cardiac auscultation could be used as an accurate and feasible screening for early screening of CHD in newborns in large-scale clinical practice.

Enhancing Neonatal Care: The Vital Role of Pulse Oximetry in the Early Screening of Critical Congenital Heart Diseases and Respiratory Diseases in Rural Areas

“…In India and many other nations, including the USA, China, and several European countries, pulse oximetry is routinely used for screening neonates for CCHD [23][24][25]. A pulse oximeter is more than just a screening tool; it is also used to evaluate how well disorders like RDS and PPHN are responding to treatment [26,27].…”

Role of artificial intelligence in early detection of congenital heart diseases in neonates

“…While this screening approach has demonstrated effectiveness in detecting critical congenital heart disease in newborns, it cannot reliably detect all types of congenital heart disease. Some forms of congenital heart disease may not lead to significant changes in oxygen saturation, and as a result, they may go unnoticed during pulse oximetry screening ( 5 ).…”

“…While echocardiography is considered the gold standard for diagnosing congenital heart disease, it typically requires more than 10 min to complete and may not be practical for every newborn, especially in resource-limited areas. In contrast, pulse oximetry provides a convenient and swift alternative, requiring only 2–3 min to analyze the results ( 5 ).…”