Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease

Abstract

Background-The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). Methods and Results-A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. Conclusions-Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic

How Accurate Is the Pulse Oximeter, and Does It Matter?

“…This confirms what has been published by Schmitt et al [2] and Ross et al [3], both cited by the authors, as well as many others [4,5,6,7]. Only one study did not find substantial differences [4].…”

Effect of Fetal Growth on 1‐Year Mortality in Neonates With Critical Congenital Heart Disease

“…CCHD was defined as one or a combination of the following lesions: hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, truncus arteriosus, total anomalous venous return, coarctation of the aorta, double outlet right ventricle, Ebstein anomaly, and single ventricle 3, 18. Additionally, we included pulmonary and aortic stenosis requiring intervention during the first year of life 18. Two study collaborators (M.A.S.…”

Coarctation of the aorta: Management from infancy to adulthood

“…Moreover, approximately 30% of neonates with coarctation remain undiagnosed upon discharge after delivery [17] . For these reasons, many physicians advocate for newborn pulse oximetry screening programs, which increase the likelihood of detecting lesions like coarctation before ductal closure [18,19] . Additionally, coarctation must be suspected in infants with other leftsided obstructive heart lesions and may be diagnosed in infants with chromosomal defects, especially those with Turner syndrome and Jacobsen syndrome [20] .…”