Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Universal oxygen saturation screening by pulse oximetry is now recommended for early detection of critical congenital heart disease. The distribution of saturations in asymptomatic newborns in a large population has not been described. WHAT THIS STUDY ADDS:Our study is the largest to date to establish simultaneous pre-and postductal oxygen saturation nomograms in asymptomatic newborns at ∼24 hours after birth. The mean postductal saturation is higher than preductal during this time.abstract OBJECTIVE: To establish simultaneous pre-and postductal oxygen saturation nomograms in asymptomatic newborns when screening for critical congenital heart disease (CCHD) at ∼24 hours after birth.METHODS: Asymptomatic term and late preterm newborns admitted to the newborn nursery were screened with simultaneous pre-and postductal oxygen saturation measurements at ∼24 hours after birth. The screening program was implemented in a stepwise fashion in 3 different affiliated institutions. Data were collected prospectively from July 2009 to March 2012 in all 3 centers. RESULTS:We screened 13 714 healthy newborns at a median age of 25 hours. The mean preductal saturation was 98.29% (95% confidence interval [CI]: 98.27-98.31), median 98%, and mean postductal saturation was 98.57% (95% CI: 98.55-98.60), median 99%. The mean difference between the pre-and postductal saturation was 20.29% (95% CI: 20.31 to 20.27) with P , .00005. Its clinical relevance to CCHD screening remains to be determined. The postductal saturation was equal to preductal saturation in 38% and greater than preductal saturation in 40% of the screens. CONCLUSIONS:We have established simultaneous pre-and postductal oxygen saturation nomograms at ∼24 hours after birth based on .13 000 asymptomatic newborns. Such nomograms are important to optimize screening thresholds and methodology for detecting CCHD.

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“…We therefore share, with caution, the concept that some authors have suggested: this method could become a standardised, objective measure in addition to the already established objective and subjective means to assess the clinical condition of a neonate. We consider that, thus far, studies of PI have proven that it could be an extremely valuable tool for the assessment of newborns’ health condition and that the future application of PI in neonatal intensive care is broad.…”

“…Contrarily, in the neonatal population, most of the studies are focused in establishing parameters for the diagnosis and/or early detection of life-threatening conditions (9,11,15,18,22,25).…”

Perfusion index in the preterm infant immediately after birth

“…Studies in the neonatal population have highlighted the potential for PI to be used as an assessment tool in various aspects of an infant's health [6]. In particular, studies have associated PI in the newborn period with subclinical chorioamnionitis [7], as a possible screening tool for the presence of congenital heart malformations [8,9], as a predictor of low superior vena cava flow [10], and as a sign of improved tissue …”

Lessons Learned From Newborn Screening for Critical Congenital Heart Defects

“…A child who has not passed the screening by the third testing is considered to have failed. Most states and hospital systems adopted this protocol, and many have reported their experiences to date, including Minnesota, 15, 16 Washington, 17 California, 18 Arkansas, 19 Wisconsin, 20 Maryland, 21 and Vermont. 22 …”

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