PULSE OXIMETRY SCREENING FOR CHD

PULSE OXIMETRY SCREENING FOR CHD

Sendelbach DM, Jackson GL, Lai SS, Fixler DE, Stehel EK, Engle WD. Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects. Pediatrics. 2008 Oct; 122(4):e815-20. [Full text] [PDF]

OBJECTIVE. The purpose of this prospective study was to assess the feasibility and reliability of pulse oximetry screening to detect critical congenital heart defects in a newborn nursery.

METHODS. The study was performed in a large urban hospital with an exclusively inborn population. Stable neonates who had a gestational age of ≥35 weeks and birth weight of ≥2100 g and in whom a critical congenital heart defect was not suspected were admitted to the newborn nursery. When the 4-hour pulse oximetry reading was <96%, pulse oximetry was repeated at discharge, and when the pulse oximetry reading remained at persistently <96%, echocardiography was performed.

RESULTS. Of 15299 admissions to newborn nursery during the 12-month study period, 15233 (99.6%) neonates were screened with 4-hour pulse oximetry. Pulse oximetry readings were ≥96% for 14374 (94.4%) neonates; 77 were subsequently evaluated before discharge for cardiac defects on the basis of clinical examination. Seventy-six were normal, and 1 had Tetralogy of Fallot with discontinuous pulmonary arteries. Pulse oximetry readings at 4 hours were <96% in 859 (5.6%); 768 were rescreened at discharge, and 767 neonates had a pulse oximetry reading at ≥96%. One neonate had persistently low pulse oximetry at discharge; echocardiography was normal. Although 3 neonates with a critical congenital heart defect had a 4-hour pulse oximetry reading of <96%, all developed signs and/or symptoms of a cardiac defect and received a diagnosis on the basis of clinical findings, not screening results.

CONCLUSIONS. All neonates with a critical congenital heart defect were detected clinically, and no cases of critical congenital heart defect were detected by pulse oximetry screening. These results indicate that pulse oximetry screening does not improve detection of critical congenital heart defects above and beyond clinical observation and assessment.

Comments. Routine pulse oximetry has been proposed as a method by which previously undetected congenital heart disease can be discovered. Studies suggested that POx screening is feasible, cost-effective, and useful in the detection of cardiac lesions that might otherwise have been missed. It is not clear from all studies what is the saturation cut-off for which CHD is suspected, and the variation in using different saturation may contribute to the false-positive or negative rates . Other contributing factors are the type of cyanotic CHD that varies in presentation. It is known that left-sided obstructive cardiac lesions such as aortic stenosis, and coarctation of the aorta may present early in life with cyanosis and pulse oximetry screening could be a useful tool. In addition, the time of performing the test is not clear as we know that some CHD will be symptomatic only when the ductus arteriosus is closed. Although this study does not support using pulse oximetry screening, I believe that more studies are needed to address all factors attributed to obtaining false negative or positive results. SAA.

Editor's Note: You can review previous articles on pulse oximetry screening for congenital heart disease at 9-023 and 4-009. ABK

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