Pulse Oximetry During the First 24 Hours as a Screening Tool For Congenital Heart Defects

Abstract

IntroductionAlthough screening for congenital heart defects (CHD) relies mainly on antenatal ultrasonography and clinical examination after birth, life-threatening cardiac malformations are often not diagnosed before the patient is discharged.AimTo assess the use of routine pulse oximetry in the delivery room and at 24 hours postpartum, and to study its feasibility as a screening test for CHD.Material and MethodsIn this prospective study, all infants born in “Cuza Voda” Maternity Hospital, Iasi, Romania, were enrolled over a thirteen-month period. Preductal oximetry was assessed during the first hour, and postductal oximetry was evaluated at twenty-four hours postpartum. Data were then analyzed to establish the sensitivity and specificity of pulse oximetry, as a screening test for CHD.Results5406 infants were included in the study, with a mean gestational age of 38.2 weeks and a mean birth weight of 3175 grams. During the first minute, blood oxygen saturation varied between 40% and 90% and at 24 hours of life, it ranged between 90% and 100%. Following oximetry assessment, 14 infants with critical CHD were identified. Blood oxygen saturation values in infants with CHD were lower throughout the entire period of evaluation. Pulse oximetry had good sensitivity and specificity at 1 hour (Se=87.5%, Sp=95.5%) and 24 hours (Se=92.5%, Sp=97.4%) for the diagnosis of CHD. Blood oxygen saturation values at one minute, 1 hour and 24 hours are strong discriminative parameters for the early diagnosis of CHD.ConclusionRoutine pulse oximetry during the first 24 hours postpartum represents an early indicator of CHD to facilitate timely intervention. Pulse oximetry provides excellent sensitivity and specificity and has tremendous potential as a standard screening test for CHD during the first 24 hours of life.

Pulse oximetry test for screening congenital heart diseases: a systematic review

“…The predominant language in which the studies were published was English and the type of study was observational, retrospective and prospective. Nine studies (20)(21)(22)25,29,30,33,39,43,44) followed a protocol to perform the test in the first 24 hours, and the others from 24 hours after birth to 48 hours.…”

“…As for the sample, it varied in the size of the studies. Most of them analyzed one hospital, but there were studies analyzing more than 14 hospitals (23,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) . Chart 1 demonstrates the characteristics of the studies, considering participants, test period, cutoff points, and care behaviors.…”

Pulse oximetry screening for critical congenital heart disease in term and late pre-term newborn

“…In our study, sensitivity of pulse oximetry screening was found to be 93% for detection of CCHD. Several studies have shown that when pulse oximetry is done in the first 24 hours of life, there can be more false positives 4,11 . In our study, pulse oximetry was done between 24-72 hours age.…”

“…Though antenatal ultrasonography usually detects major CHD, they can be missed, especially in developing countries, because of the absence of routine antenatal visits 4 . Pulse oximetry is a noninvasive tool used to detect CCHD 5,6 .…”

Our screening results for critical congenital heart disease in newborns

“…Erken yapılan bir çalışmada 4. saatte taramada özgüllük %94, duyarlılık %75, yalancı pozitiflik %5,6 bulunmuştur [15]. Başka bir çalışmada 1. saatte özgüllük %95,5, duyarlılık %87,5 iken 24. saatinde özgüllük %97,5; duyarlılık %92,5 saptanmış ve doğum sonrası ilk saat boyunca pulse oksimetre takibinin zamanında müdahaleyi kolaylaştırmak için KKH'nin erken bir göstergesi olduğu belirtilmiştir [16]. Geç tarama, 24 saatten sonra yapılır, iş yükü daha az, yalancı pozitiflik daha az, ancak bazı olgularda tanıda gecikme riski olabilir [8].…”