Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic new-borns
Keywords:Pulse, Congenital, Oxygen, Vascular, Malformation
Background:Congenital Cardio-Vascular Malformations (CCVMs) are relatively common with a prevalence of 5-10 in every 1000 live births. CCVM represents a new-born condition that would be ideally suited to a screening program if simple and reliable methods were available. Pulse oximetry has been proposed as a screening method for the detection of congenital heart defects.
Methods:Hospital based prospective non-randomized study conducted over a period of one year at the department of pediatrics in G.B. Panth hospital (Neonatology) and L.D. hospital (Neonatology). A total of 1200 asymptomatic new-borns attending G.B. Panth, neonatology/L.D. neonatology were screened with pulse oximetry. Oximetric screening for CCVM was performed by obtaining a single determination of postductal saturation at >24 hours. All new-borns underwent additional evaluation by echocardiography.
Results:Out of 1200 newborns screened three had postductal saturation ≤95%. Echocardiography revealed TGA (transposition of great vessels) in one; TA (truncus arteriosus) in other and third one had structurally normal heart on echocardiography. There was one false negative screen (found in the inpatient records of G.B. Panth hospital). The sensitivity, specificity, positive predictive value and negative predictive value of pulse oximetry in screening for CCVM in asymptomatic new-borns was found to be 66.67%, 99.9%, 66.67% and 99.9% respectively.
Conclusion:This screening test is simple, non-invasive and inexpensive. The sensitivity, specificity, and predictive value in this population were satisfactory, indicating that screening should be applied to larger populations, particularly in developing countries where lower rates of detection result in increased CCVM prevalence in asymptomatic new-borns.
Payne RM, Johnson MC, Grant JW, Strauss AW. Toward a molecular understanding of congenital heart disease. Circulation. 1995;91:494-504.
Druschel C, Hughes JP, Olsen C. Mortality among infants with congenital malformations in New York State, 1983-1988. Publ Health Rep. 1996;111:359-65.
Sharland G. Changing impact of fetal diagnosis of congenital heart disease. Arch Dis Child. 1997;77:F1-3.
Fernandez CO, Ramaciotti C, Martin LB, Twickler DM. The four chamber view and its sensitivity in detecting congenital heart defects. Cardiology. 1998;90:202-6.
Wren C, Richmond S, Donaldson L. Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed. 1999;80: F49-53.
Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979-1997. Circulation. 2001;103:2376-81.
Mississippi 2005 Regular Session. House bill No. 1052, 2005. Available at: http://billstatus.ls.state.ms.us/documents/2005/pdf/HB/1000-1099/HB1052IN.pdf.
Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart. 2006;92:1298-302.
Brown JW, Park HJ, Turrentine MW. Arterial switch operation: factors impacting survival in the current era. Ann Thorac Surg. 2001;71:1978-84.
Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart. 2002; 87: 67-9.
Tworetsky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation. 2001;103:1269-73.
Cartlidge PH. Routine discharge examination of babies: is it necessary? Arch Dis Child. 1992;67:1421-2.
Bull C, for the British Paediatric Cardiac Association. Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK. Lancet. 1999;354:1242-7.
Tegnander E, Williams W, Johansen OJ, Blaas H-GK, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30149 fetuses - detection rates and outcomes. Ultrasound Obstet Gynecol. 2006;27:252-65.
Garne E, Stoll C, Clementi M, the Euroscan Group. Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries. Ultrasound Obstet Gynecol. 2001;17:386-91.
Hoke TR, Donohue PK, Bawa PK, Mitchell RD, Pathak A, Rowe PC, et al. Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study. Pediatr Cardiol. 2002;23:403-9.
Richmond S, Reay G, Abu Harb M. Routine pulse oximetry in the asymptomatic new-born. Arch Dis Child Fetal Neonatal Ed. 2002;87:F83-8.
Reich JD, Miller S, Brogdon B, Casatelli J, Gompf TC, Huhta JC, et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr. 2003;142:268-72.
Koppel RI, Druschel CM, Carter T, Goldberg BE, Mehta PN, Talwar R, et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic new-borns. Pediatrics. 2003 Mar;111(3):760-1.
de Wahl Granelli A, Mellander M, Sunnegardh J, Sandberg K, Ostman-Smith I. Screening for duct-dependant congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity. Acta Paediatr. 2005;94:1590-6.
Rosati E, Chitano G, Dipaola L, De Felice C, Latini G. Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease. J Perinat Med. 2005;33:455-7.
Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol. 2005;26:832-5.
Arlettaz R, Bauschatz AS, Monkhoff M, Essers B, Bauersfeld U. The contribution of pulse oximetry to the early detection of congenital heart disease in new-borns. Eur J Pediatr. 2006;165:94-8.
Meberg A, Brügmann-Pieper S, Due R Jr, Eskedal L, Fagerli I, Farstad T, et al. First day of life pulse oximetry screening to detect congenital heart defects. J Pediatr. 2008;152:761-5.
Sendelbach DM, Lai S, Jackson GJ, Fixler D, Stehel EK, Engle WD. Pulse oximetry (POx) screening of term and late pre-term neonates at 4 hours postnatal (PN) to detect cyanotic congenital heart disease (CCHD). Presented at: Honolulu, Hawaii: Pediatric Academic Societics; May 2-6, 2008. Abstract E-PAS2008:5896.2.
Riede FT, Wörner C, Dähnert I, Möckel A, Kostelka M, Schneider P. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine: results from a prospective multicenter study. Eur J Pediatr. 2010 Aug;169(8):975-81.
Tautz J, Merkel C, Loersch F, Egen O, Hagele F, Thon HM, et al. Implication of pulse oxymetry screening for detection of congenital heart defects. Klin Pediatr. 2010 Sep;222(5):291-5.
Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, et al. Role of pulse oximetry in examining new-borns for congenital heart disease: a scientific statement from AHA and AAP. Pediatrics. 2009 Aug;124(2):823-36.