An update work of pulse oximetry screening for detecting critical congenital heart disease in the newborn

A Taksande, R Meshram, A Lohakare, S Purandare, U Biyani, J Vagha
Images in Paediatric Cardiology 2017, 19 (3): 12-18

Background: Congenital Heart Disease (CHD) is the commonest group of congenital malformations and affects 7-8 per 1000 live born newborns. Nevertheless, it is estimated that more than 50% of babies with undiagnosed CHD are not detected by routine neonatal cardiac examination.

Aim: To find the incidence of CHD in newborns and to determine the accuracy of pulse oximetry for detecting clinically unrecognized critical congenital heart disease (CCHD) in the newborns.

Methods: Pulse oximetry was performed on clinically normal newborns within 4 hours of first day of life. Inclusion criteria: All newborns who were admitted in postnatal ward & Neonatal Intensive care unit (NICU). Exclusion criteria: babies and neonates with a prenatal diagnosis of duct dependent circulation. If oxygen saturation (SpO2 ) was below 90%, then echocardiography was performed.

Results: During the study period, 4926 live born neonates were examined. Nine out of 12 neonates with SpO2<90% had CCHD. Four neonates had tetralogy of Fallot (TOF), two had tricuspid atresia, two had transposition of great arteries (TGA) and one had truncus arteriosus. The incidence of CHD was 33.49 per 1000 live births and CCHD was 1.82 per 1000.  A pulse oximetry cut-off value of below 90% for detecting CCHD showed 90% sensitivity, 99.94% specificity, 75% positive predictive value (PPV) and 99.98% negative predictive value (NPV).

Conclusion: Pulse oximetry is safe, feasible and noninvasive and also used to screen for CCHD. It is the nice method to detect the CHD along with the physical examination of neonates by medical personal.

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