Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter October 1, 2005

Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease

  • Enrico Rosati , Giovanna Chitano , Lucia Dipaola , Claudio De Felice and Giuseppe Latini

Abstract

Aims: Critical congenital cardiovascular malformations (CCVMs) require surgical correction during the first month of life, physical examination is unable to detect >50% of affected infants. An oximetry screening has been previously proposed. Our aim was to verify the usefulness and consistency of a pulse oximetry screening for early detection of CCVMs in a small size nursery.

Methods: A single determination of SpO2 was performed on 5292 consecutive apparently healthy newborns, discharged from nursery at a median age of 72 h during the period May 1, 2000 and November 30, 2004. Infants showing signs of congenital heart disease before the screening and those with a prenatal diagnosis were excluded. Cardiac ultrasound was performed on all infants with SpO2≤95% at >24 h. The accuracy of the screening in identifying CCVMs was assessed by receiver-operating characteristic (ROC) curves analysis.

Results: We found 2 (0.038%) true positives, 1 (0.019%) false negative, 1 (0.019%) false positive, and 5288 (99.92%) true negatives. Prevalence of critical CCVMs was 1 in 1764. Clinical follow-up showed no evidence of CCVMs in the negative cases. A pulse-oximetry cut-off value of ≤95% showed 66.7% sensitivity (95% CI: 11.6–94.5), 100% specificity (95% CI: 99.9–100.0), 50% positive predictive value, 100% negative predictive value and AUC of 0.833 (standard error: 0.145) (95% CI: 0.823 to 0.843) in identifying CCVMs.

Conclusions: Our findings indicate that pulse oximetry is a non-invasive and specific screening tool for an early detection of CCVMs, and is easily applicable to a small size nursery.

:

Corresponding author: Latini G., MD. Division of Neonatology Perrino Hospital S.S. 7 per Mesagne 72100 Brindisi Clinical Physiology Institute National Research Council of Italy Lecce Section (IFC-CNR) Italy Tel.: +39-0831-537471 Fax: +39-0831-537861

References

1 Druschel C, JP Hughes, C Olsen: Mortality among infants with congenital malformations in New York State, 1983–1988. Public Health Rep111 (1996) 359Search in Google Scholar

2 Hanley JA, BJ McNeil: The meaning and use of the area under the Receiver Operating Characteristic (ROC) curve. Radiology143 (1982) 29Search in Google Scholar

3 Hanley JA, BJ McNeil: A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology148 (1983) 839Search in Google Scholar

4 Hoke TR, PK Donohue, PK Bawa, RD Mitchell, A Pathak, PC Rowe, et al.: Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study. Pediatr Cardiol23 (2002) 403Search in Google Scholar

5 Koppel MD, CM Druschel, T Carter, BE Goldberg, PN Mehta, R Talwar, et al.: Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics111 (2003) 451Search in Google Scholar

6 Kuehl KS, CA Loffredo, C Ferenez: Failure to diagnose congenital heart disease in infancy. Pediatrics103 (1999) 743Search in Google Scholar

7 Malkin JD, S Garber, MS Broder, E Keeler: Infant mortality and early postpartum discharge. Obstetrics & Gynecology96 (2000) 183Search in Google Scholar

8 Meberg A, JE Otterstad, G Froland, J Hals, SJ Sorland:Early clinical screening of neonates for congenital heart defects: the cases we miss. Cardiol Young9 (1999) 169Search in Google Scholar

9 New York State Department of Health Congenital Malformations Registry Annual Report. Albany, NY: New York State Department of Health 1997Search in Google Scholar

10 Pass KA: Not as pink as you think! Pediatrics111 (2003) 67010.1542/peds.111.3.670Search in Google Scholar PubMed

11 Payne RM, MC Johnson, JW Grant, AW Strauss: Toward a molecular understanding of congenital heart disease. Circulation91 (1995) 494Search in Google Scholar

12 Richmond S, G Reay, M Abu Harb: Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed87 (2002) F8310.1136/fn.87.2.F83Search in Google Scholar PubMed PubMed Central

13 Reich JD, S Miller, B Brogdon, J Casatelli, TC Gompf, JC Hutha, et al.: The use of pulse oximetry to detect congenital heart disease. J Pediatr142 (2003) 268Search in Google Scholar

14 Wren C, S Richmond, N Donaldson: Presentation of congenital heart disease in infancy: implication for routine examination. Arch Dis Child Fetal Neonatal Ed80 (1999) F4910.1136/fn.80.1.F49Search in Google Scholar PubMed PubMed Central

Published Online: 2005-10-01
Published in Print: 2005-10-01

©2005 by Walter de Gruyter Berlin New York

Downloaded on 2.3.2024 from https://www.degruyter.com/document/doi/10.1515/JPM.2005.080/html
Scroll to top button