Diagnostic accuracy of pulse oximetry screening for critical congenital heart defects

Plana, Maria; Zamora, Javier; Suresh, Gautham; Fernández-Pineda, Luis; Thangaratinam, Shakila; Ewer, Andrew K

doi:10.1002/14651858.cd011912

Cited by 6 publications

(9 citation statements)

References 37 publications

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“…Interestingly, a systematic review noted that POS can identify 5 out of 6 babies with CCHD. Furthermore, the false positive rate is 0.06% and 0.42%, when POS is done after 24 hours of age and before 2 hours of age, respectively 10 . Therefore, POS has gained popularity across the world for detection of CCHD.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

Gamhewage

Perera

Weerasekera

2021

Sri Lanka J Child Health

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Background: Critical congenital heart disease (CCHD) constitutes a spectrum of different heart anomalies needing intervention early in life for survival. Pulse oximetry screening (POS) claims to have a sensitivity of 60%, specificity of 99.95%, positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 99.98% in detecting CCHD.Objectives: To assess the effectiveness of POS in identifying CCHD in a tertiary care neonatal unit in Sri Lanka.Method: A prospective descriptive study was carried out at Sri Jayewardenepura General Hospital (SJGH) from October 2017 to March 2020 including all healthy newborns delivered at SJGH. Babies with a prenatal diagnosis of CHD and those who needed admission to neonatal unit before POS was performed were excluded. Recruited babies underwent POS after 24 hours, but before 48 hours of life, in addition to routine newborn examination.Results: There were 8964 live births during the study period. POS was carried out in 8718 babies and was positive in 19 babies; 18 babies had CHD confirmed by echocardiogram, out of which 14 had CCHD. Hence, the incidence of CCHD, identified by POS was 1.56 per 1000 live births. Furthermore, POS demonstrated a PPV of 73.7%, and a false positive rate of 0.06%.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

Gamhewage

Perera

Weerasekera

2021

Sri Lanka J Child Health

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“…Another limitation of our study was the high false positive rate of 0.7%, compared to the rate of 0.14% in previous studies [4]. This is likely explained by the fact that our screening programme involves performing pulse oximetry screening between 4-12 hours after birth.…”

Section: Discussionmentioning

confidence: 66%

“…Globally, many research studies have been performed on pulse oximetry screening for detection of critical CHDs [4], [12]- [14], [18], [19], [22]. Most have focused on the detection of CCHDs and non-cardiac conditions by POS: there remains a paucity of data on missed cases of CCHD and major CHDs not detected by pulse oximetry screening.…”

Section: Discussionmentioning

confidence: 99%

“…Globally, congenital heart disease, sepsis and lower respiratory tract infections remain the most common causes of neonatal mortality [1]. The prevalence of congenital heart defects (CHDs) is around 7-9 per 1000 live births [2]; they account for just under 50% of deaths from all congenital anomalies, and up to 10% of all infant deaths in the Western world [3], [4]. Critical CHDs (CCHDs), comprising up to 30% of all CHDs, are de ned by conditions needing surgery, intervention, or resulting in death, within one month after birth [5].…”

Section: Introductionmentioning

confidence: 99%

“…The addition of pulse oximetry screening (POS) can improve detection of CCHDs to around 75-90% [12], [13]. Previous studies have shown POS is accurate, cost effective and acceptable to both parents and clinical staff [4], [12]- [17]. Pulse oximetry screening is based on the rationale that asymptomatic infants with CHDs will have some degree of hypoxaemia that may not be clinically ascertainable, or a difference in oxygen content between pre-and post-ductal circulations [14] , [18].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Pulse Oximetry Screening to Detect Congenital Heart Defects: 5 Years’ Experience in a Regional Neonatal Unit in the UK

Singh

Chen

2021

Preprint

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Pulse oximetry screening (POS) has been shown to be an effective and non-invasive investigation that can detect up to 50-70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on the clinical practice. All the eligible newborn infants born between Jan 2015 and Dec 2019 in busy regional neonatal unit were included in the prospective observational study. Of the 25185 eligible infants, 189 (0.8%) infants had a true positive results: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 infants had significant non-cardiac conditions. 43 infants who had a normal POS were later (post-hospital discharge) diagnosed with following category of CHDs: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7% and its specificity was 99.3%. However, its sensitivity for detection of all the major CHDs needing surgery during infancy was 33%.ConclusionPulse oximetry screening showed moderate and high sensitivity in detection of undiagnosed critical CHDs, however it failed to detect two-third of the major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods to detect other major CHDs missed by pulse oximetry screening and other current screening tools.

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Implementation of a Regional Standardised Model for Perinatal Electronic Medical Records

et al. 2022

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Background:Electronic recording of newborn health information contributes to improving the quality of care.Nonetheless, there is limited evidence on the implementation of perinatal electronic medical records models. We describe the development and implementation of an electronic recording model that includes data on the health care provided to both the mother and the newborn, standardised for six hospitals of a regional health care system. Methods:The implementation process was developed in 2 stages. During stage 1, the tool was introduced in hospitals to stablish rst contact with the healthcare staff. The second stage consisted in designing a new strategy to stabilise the model. Technical issues were xed, and a new version was drawn up based on multidisciplinary agreement. Indicators to monitor implementation were measured in both stages and compared using the chi-squared test. Results:During stage 1, nearly every newborn got its electronic medical record with an appropriate connection to the mother's data. However, certain forms that were meant to be lled in by staff were frequently neglected (completion rates: 36.7%-55.3%). In stage 2, there was a statistically signi cant increase in the completion rates of all these forms. As a result, a standardised discharge report was provided to every newborn at the end of stage 2. Conclusions:Implementation of perinatal electronic medical records that link maternal and neonatal data is complicated and experience in this area is limited. Here we describe the implementation process of a model that was reliable and standardised for an entire regional health care system.

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Diagnostic accuracy of pulse oximetry screening for critical congenital heart defects

Cited by 6 publications

References 37 publications

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

Impact of Pulse Oximetry Screening to Detect Congenital Heart Defects: 5 Years’ Experience in a Regional Neonatal Unit in the UK

Implementation of a Regional Standardised Model for Perinatal Electronic Medical Records

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