Pulse oximetry screening: a review of diagnosing critical congenital heart disease in newborns

Abstract

Congenital heart disease (CHD) is one of the most common birth defects, with an incidence of nine out of every 1,000 live births. The mortality of infants with CHD has decreased over the past 3 decades, but significant morbidity and mortality continue to occur if not diagnosed shortly after birth. Pulse oximetry was recommended as a screening tool to detect critical CHD in 2011 by the American Academy of Pediatrics and the American Heart Association. Pulse oximetry is a tool to measure oxygen saturation, and based on the presence of hypoxemia, many cardiac lesions are detected. Due to its ease of application to the patient, providing results in a timely manner and without the need for calibrating the sensor probe, pulse oximetry offers many advantages as a screening tool. However, pulse oximetry has also important limitations of which physicians should be aware to be able to assess the significance of the pulse oximetry measurement for a given patient. This review aims to highlight the benefits and shortcomings of pulse oximetry within the context of screening for critical CHD and suggests future avenues to cover existing gaps in current practices.

Does pulsatility index add value to newborn pulse oximetry screening for critical congenital heart disease?

“…Pulse oximetry is highly specific and moderately sensitive, especially when performed within 24–48 hours of life 2 8 10 11. It significantly improves the overall detection of cCHD when used in combination with newborn examination and antenatal scanning, and may additionally highlight other pathologies 12 13. This was recently demonstrated in the 2018 Cochrane review 14.…”

“…This was recently demonstrated in the 2018 Cochrane review 14. Pulse oximetry struggles, however, to consistently detect left heart obstructive disease, such as coarctation of the aorta, interrupted aortic arch and hypoplastic left heart syndrome, as initially these may not be associated with abnormal saturations 12 15…”

Perinatal cardiology: the present and the future. Part I: congenital heart disease

“…Engel и соавт. [17] продемонстрировало ограниченность изолированного пульсоксиметрического скрининга в выявлении целого ряда критических врожденных пороков сердца. Так, к врожденным порокам сердца с низкой вероятностью выявления этим методом относятся аортальный стеноз с открытым артериальным протоком, стеноз легочной артерии и полная форма атриовентрикулярной коммуникации.…”

“…Существует целый ряд пороков сердца, которые НЕВОЗ-МОЖНО выявить путем пульсоксиметрического скрининга. К ним относятся коарктация аорты без открытого артериального протока, аномалия Эбштейна без право-левого сброса, аортальный стеноз без открытого артериального протока и другие врожденные пороки сердца с лево-правым сбросом крови [17]. Чаще других пропускается коарктация аорты: по данным C. Peterson и соавт.…”

First steps to a clinical research unit for developmental research in paediatric cardiology: conception and progress of the LEADER project (Long Term Early Development Research) in CHD

“…Congenital heart disease (CHD) represents a group of malformations of the heart present at birth that significantly contributes to infant mortality and morbidity. 1,2 In recent years, major improvements in the medical care for children with CHD have occurred, [3][4][5][6] which have led to increased survival rates. 7,8 Consequently, there is growing interest in studying long-term morbidity and quality of life of these patients.…”