Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit

Abstract

Critical congenital heart disease (CCHD) screening is effective in asymptomatic late preterm and term newborn infants with a low false positive rate (0.035%). Objective (1) To compare 2817 NICU discharges before and after implementation of CCHD screening; and (2) to evaluate CCHD screening at < 35 weeks gestation. Methods collection of results of CCHD screening including preductal and postductal SpO2 values. Results During the pre-CCHD screen period, 1247 infants were discharged from the NICU and one case of CCHD was missed. After 3/1/12, 1508 CCHD screens were performed among 1570 discharges and no CCHDs were missed. The preductal and postductal SpO2 values were 98.8±1.4% and 99±1.3% respectively in preterm and 98.9±1.3% and 98.9±1.4% in term infants. Ten infants had false positive screens (10/1508=0.66%). Conclusions Performing universal screening in the NICU is feasible but is associated with a higher false positive rate compared to asymptomatic newborn infants.

Epidemiology and Clinical Research Design, Part 2: Principles

“…In addition, practitioners, patients, and parents may experience a false sense of security when they are informed that the infant has passed the “heart disease screen.” This may potentially delay the diagnosis of conditions (such as coarctation of aorta) that may be missed by this screening test. (14)(15) (16)(17)(18) Other risks inherent to the screening test itself, such as radiation with plain radiography or computed tomography (for detecting lung cancer), should also be considered. Presymptomatic state: The onset of symptoms marks an important point in the natural history of a disease. Primary prevention refers to preventing development of the disease by reducing exposure to disease-causing agents (intrapartum antibiotic prophylaxis to reduce group B streptococcal disease) or by modifying behavior (eg, smoking and exercise) or immunization.…”

“…In addition, practitioners, patients, and parents may experience a false sense of security when they are informed that the infant has passed the “heart disease screen.” This may potentially delay the diagnosis of conditions (such as coarctation of aorta) that may be missed by this screening test. (14)(15) (16)(17)(18) Other risks inherent to the screening test itself, such as radiation with plain radiography or computed tomography (for detecting lung cancer), should also be considered.…”

The role of pulse oximetry in neonatal screening for critical and complex congenital heart defects

“…Более опти-мистичная статистика публикуется в США: там количество случаев поздней диагностики кри-тических врожденных пороков сердца составля-ет 7 на 100 000 живорожденных [13]. Однако даже в рамках такой продвинутой системы здравоох-ранения, как в США, только 35-45% новорожден-ных, проходящих через службы неонатальных реанимаций, получают консультацию детского кардиолога и экспертное эхокардиографическое исследование [14].…”

Lessons Learned From Newborn Screening for Critical Congenital Heart Defects

“…9 Given that premature infants typically have lower saturations than term infants, screening in the NICU can lead to a higher false-positive rate than in the newborn nursery. 38 This concern for higher false-positive rates and the lack of clear guidelines for screening in the ICU or intermediate care nurseries have led to wide variation in practice. Many units perform CCHD screening according to the standard AAP protocol, whereas others have modified the protocol based on timing or use of supplemental oxygen.…”