Pulse oximetry screening for critical congenital heart disease: a comparative study of cohorts over 11 years

Banait, Nishant; Platt, Martin Ward; Abu-Harb, Majd; Wyllie, Jonathan; Miller, Nicola; Harigopal, Sundeep

doi:10.1080/14767058.2018.1538348

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…In our study, the post-discharge diagnosis rate of CCHD was 4/100,000. From a retrospective multicentre cohort study of 138,176 infants, Banait et al [ 29 ] reported that the rate of post-discharge diagnosis of CCHDs was almost doubled in infants with no pulse oximetry screening; 7/100,000 in cohorts with POS screening versus 13/100,000 in populations without POS screening (relative risk 0.52, CI 0.2 to 1.42) [ 29 ]. However, this difference was not statistically significant which could be because of the small number of CCHDs in the large cohort study.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Singh

Chen

2021

Eur J Pediatr

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Pulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50–70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%.Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools. What is Known:• Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects.• Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee. What is New:• To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Singh

Chen

2021

Eur J Pediatr

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“…Pulse oximetry screening revealed 6/7 (85.7%) cases of CCHD prior to hospital discharge. The rate of postdischarge CCHD diagnosis was nearly doubled in neonates without pulse oximetry screening, according to a different study by [31]; it was 7/100,000 in cohorts with POS screening compared to 13/100,000 in cohorts without POS screening (relative risk 0.52, CI 0.2 to 1.42). The small number of CCHDs in the big cohort study may have contributed to the difference's lack of statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Pulse Oximetry Screening for Congenital Heart Disease

El Bakry,

Abd el Hie,

Amin

et al. 2024

Benha Medical Journal

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Background: Lower respiratory tract infections, sepsis, and congenital heart disease are still the main causes of new-born death, but most of these issues are curable with early detection and treatment. It has been established that pulse oximetry screening (POS) is a non-invasive investigation that can identify 50-70% of congenital heart defects (CHDs) that have not been identified before. The aim of this study is to count the number of participants with congenital heart disease who were found through early screening-using pulse oximetry. Methods: A prospective study was conducted on new-borns patients with congenital heart disease -who admitted to the well-baby nursery and neonatal intensive care unit (NICU) of implementation-was performed at 2 tertiaries hospitals, (Dubai hospital in United Arab Emirates and Benha university hospital in Egypt) on all deliveries born from June 2014 through December 2016. Results: there were 41 patients had pulse oximetry≤90 (27.7%), 73 patients had pulse oximetry≤92 (49.3%) and 114 patients had pulse oximetry≤95 (77.0%). Also, the initial pulse oximetry different was ranged (3.00-6.00) with mean (3.88±1.02) and the second pulse oximetry different was ranged (2.00-7.00) with mean (4.01±1.22). Conclusion: Even in the first hour of life, oxygen saturations were found to be abnormal in the majority of CCHD patients. The proportions of anomalous results were highest with the highest oxygen saturation threshold (95%).

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“…Our data compare favourably with the largest reported UK cohort undergoing POS that was published in 2020 and analysed data from over 138 000 babies (76 232 screened using POS) over an 11-year period (2001-2011). 21 Only data on CCHD detection were reported and a comparison between two screening, and one non-screening, hospitals was made. The rate of postdischarge diagnosis in the screened population was 7/100 000 and 13/100 000 in the unscreened population.…”

Section: Original Researchmentioning

confidence: 99%

Temporal trends in routine predischarge pulse oximetry screening: 6 years’ experience in a UK regional neonatal unit

Henderson

Aguirre

Singh

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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ObjectivesTo evaluate the continued impact of pulse oximetry screening (POS) in a regional neonatal unit (NNU) and identify trends in screening outcomes in comparison with our previous experience.DesignRetrospective review of admissions between April 2013 and March 2019 (the current study) and comparison with previously published data (the 2014 study).PatientsAll infants >34 weeks completed gestation admitted to NNU as a result of positive POS.Outcome measuresIndication for admission, diagnosis, investigations and management.ResultsThere were 49 375 livebirths and 253 NNU admissions as a result of positive POS (0.5% of livebirths; compared with 0.8% in 2014). 247/253 (97.6%) of those admitted had a significant diagnosis requiring medical intervention (compared with 79% in 2014) and the proportion of healthy babies (with transitional circulation) admitted decreased from 21% to 2.4%.22 (9%) babies admitted as a result of a positive POS were found to have a previously undiagnosed congenital heart defect (CHD) of which eight were critical CHDs (CCHDs). This accounted for 73% of all undiagnosed CCHD undergoing POS. The antenatal detection rate of CCHD was 75% compared with 46% in 2014. No baby died or collapsed on the postnatal ward during the study period. The proportion of babies with CCHD identified before discharge improved from 94% to 99%.ConclusionsRoutine POS, in addition to antenatal screening and postnatal examination, continues to contribute to the improvement of our overall CCHD detection rates. We have demonstrated an overall reduction in the admission of healthy babies and therefore workload following a positive test.

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Pulse oximetry screening for critical congenital heart disease: a comparative study of cohorts over 11 years

Cited by 7 publications

References 18 publications

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Neonatal Pulse Oximetry Screening for Congenital Heart Disease

Temporal trends in routine predischarge pulse oximetry screening: 6 years’ experience in a UK regional neonatal unit

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