Pulse oximetry screening for critical congenital heart disease in the neonatal intensive care unit

Goetz, Elizabeth M.; Magnuson, Karen M.; Eickhoff, Jens; Porte, Michael; Hokanson, John S.

doi:10.1038/jp.2015.150

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…Second, we quantified FPRs as a mechanism to evaluate burden of screening. Of the four US studies conducted, three reported no failed screens 10, 11, 12 with the fourth reporting 13 a FPR (0.7%) that was similar to our overall findings, yet higher than that of asymptomatic newborns. 22 de-Wahl Granelli et al 23 reported a FPR of 0.2% in the well-baby nursery for infants screened using both extremities at >24 h excluding those with a prenatal CHD diagnosis.…”

Section: Discussionsupporting

confidence: 86%

“…10, 11, 12, 13, 18, 19 Our protocol of screening infants at 24 to 48 h, including those receiving supplemental oxygen, aimed to address these issues. Aware that target saturations for infants receiving supplemental oxygen may be intentionally lower, our modification of only requiring a rescreen for >3% pre- and post-ductal differential or saturations <95% inconsistent with clinical profile, afforded the ability to minimize false positives and potentially aid in early detection of aortic arch anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…10, 11, 12, 13 Faced with mandated screening and minimal empiric evidence to guide implementation in the NICU, salient questions have been raised regarding appropriate exclusion criteria, timing, influence of supplemental oxygen and resource utilization. We performed a prospective, multicenter evaluation of CCHD screening in the NICU.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

et al. 2017

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Objective:To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening.Study Design:Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants).Results:Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%).Conclusion:Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

et al. 2017

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“…The majority of screens performed at >72 hours of life occurred in infants who had been admitted to the NICU and were receiving supplemental oxygen. Goetz et al 12 found similar results in their NICU population, with 67.4% of infants screened at >48 hours due to oxygen requirements. Other studies have highlighted problems with POxS in the NICU, 12–14 and this is an area that requires further study to develop an optimal screening protocol.…”

Section: Discussionmentioning

confidence: 58%

Evaluation of a Screening Program to Detect Critical Congenital Heart Defects in Newborns

Klausner

Shapiro

Elder

et al. 2017

Hospital Pediatrics

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OBJECTIVES To report the results of and to identify problems with implementing a screening program to detect critical congenital heart defects (CCHDs) in newborns by using differential pulse oximetry (POx). METHODS Charts of all live-born infants from 4 Yale–New Haven health system hospitals in Connecticut between January 1 and December 31, 2014, were reviewed. RESULTS Of 10 589 newborns, 171 (1.6%) underwent an echocardiogram before screening, 10 320 (97.5%) were screened by POx, and 98 (0.9%) were not screened. Thirteen newborns (0.1%) were diagnosed with a CCHD. No infants with CCHDs were identified through POx screening (POxS) alone. Eleven (85%) were already suspected of having a CCHD lesion on the basis of prenatal ultrasound, 1 (8%) was diagnosed because of clinical concern before undergoing screening, and 1 (8%) had a false-negative screening result, but a CCHD was identified after an echocardiogram was performed because a murmur was heard. Four infants with a positive POx screen showed noncritical cardiac lesions by echocardiogram. The majority of infants were screened within the recommended 24 to 72 hours of age interval and had POx screens that were interpreted and documented correctly. Of 10 316 infants with negative POx screens, 52.1% were still in the Yale–New Haven Hospital health system at 1 year of age and no CCHD lesions were listed in their charts. CONCLUSIONS Although a CCHD screening program was effectively implemented, perhaps because most children with a CCHD (85%) were detected antenatally by ultrasound, in our hospital system POxS did not lead to a substantial increase in the early identification of CCHDs.

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“…A pulse oxymetry at room in the lower extremities (postductal saturation) may of great value. A pulse oxymetry above 96% rules out a completely ductal-dependent left heart obstruction (hypoplastic left heart or interrupted aortic arch) [22].…”

Section: Congenital Heart Diseasementioning

confidence: 99%

A Practical Approach to Emergencies in the Neonatal Period

Perez¹,

Soto-Martinez²

2014

J Neonatal Biol

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All emergency departments should be prepared to care for a critically ill infant, including having the appropriate sized equipment. The most common diagnosis in admitted neonates include respiratory infections, sepsis, congenital heart disease, bowel obstruction, hypoglycemia and seizures. Febrile neonates are at high risk for sepsis and therefore need blood, urine and CSF testing. These patients should receive empiric antibiotic therapy in hospital. There are many life-threatening illness that can affect this population and is the responsibility of the emergency physician to assess the neonate, stabilize, narrow the differential diagnosis to the most likely and begin life-sustaining treatment. Very different types of illnesses can affect a child in the neonatal period and some can give us different clinical presentation. For example, the spectrum of congenital heart disease presenting in the newborn period and early infancy ranges from benign to catastrophic. Neonatal seizures may have subtle manifestations and require a different approach than seizures in older infants and children. This is a review of the more common but life threatening pathologic conditions in the neonate if not managed adequately.

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Pulse oximetry screening for critical congenital heart disease in the neonatal intensive care unit

Abstract: POS can be performed in the NICU with minimal adverse effects. However, in many NICU patients CCHD is confirmed or excluded before POS, and POS will frequently be performed after CCHD would have been expected to become symptomatic.

Cited by 15 publications

References 12 publications

Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

Evaluation of a Screening Program to Detect Critical Congenital Heart Defects in Newborns

A Practical Approach to Emergencies in the Neonatal Period

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