The Road to Universal Pulse-Oximetry Screening: Are We There Yet?

Cuzzi, Sandra; Bradshaw, Elizabeth A.

doi:10.1542/peds.2011-2475

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…Therefore, most publications have recommended that pulse oximetry screening be performed at ≥24 hours of age. 9 , 13 , 15 The positive predictive value (18%) was similar with other studies (UK [13.3%], Sweden [30.7%], Germany [25.9%], Poland [51.7%], and Norway [8.3%]). 5 , 7 , 8 , 10 , 13 , 17 The sensitivity 77% and specificity 98% in our study were similar among the international studies, 75% and 99.3% in a UK; 5 79% and 99.8% in Swedish study, 7 77.78% and 99.9% in a German study, 8 78.9% and 99.9% in Poland, 10 and 77.1% and 99.4% in Norway.…”

Section: Discussionsupporting

confidence: 88%

“…On the other hand, some newborns passed the test but were diagnosed later as having congenital heart disease. 1 , 15 We applied the Saudi MOH protocol in our study ( Table 1 ), which included screening between 12 and 24 hours of age and repeating the test after one hour if the initial saturation was between 90% and 95% or ≥95% with a difference >3%. This protocol could have increased the number of positive results relative to those of other international studies ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

“… 12 - 14 It is important to recognize that a baby with a failed screening result (does not meet the criteria of a disease) can appear to be completely well on examination, but have a significant underlying medical problem. 13 , 15 The Saudi Ministry of Health (MOH) recommended and added CCHD screening to the country’s newborn screening programs. Screening at age 24 hours is now performed in many centers in Saudi Arabia, with clear guidance that is compatible with the guidance of AAPs 6 and AH to facilitates successful screening.…”

mentioning

confidence: 99%

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Effectiveness of the critical congenital heart disease screening program for early diagnosis of cardiac abnormalities in newborn infants

Almawazini

Hanafi

Madkhali

et al. 2017

SMJ

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Objectives:To evaluate the effectiveness of critical congenital heart disease (CCHD) screening program for early diagnosis of cardiac anomalies in newborn infants.Methods:This is a hospital-based prospective cross-sectional study conducted in the Pediatric and Neonatology Department, King Fahad Hospital at Albaha, Saudi Arabia, between February 2016 and February 2017.Results:We screened 2961 (95.4%) of 3103 patients in a nursery unit; 142 (4.6%) patients were not screened. The test was positive in 114 (3.9%) patients and negative in 2847 (96.1%). There were 94 (3.2%) false positives and 20 (0.7%) true positives. Critical cardiac defects were diagnosed in 7 (0.2%) patients of all screened infants, and severe pulmonary hypertension was diagnosed in 13 (0.4%) patients. True negative results were found in 2841(96%) patients, and no cardiac defect was diagnosed, whereas false negative results were seen in 6 (0.2%) patients diagnosed with ventricular septal defect. The sensitivity was 77%, and the specificity was very high at 97%, with a positive predictive value of 18%, and a negative predictive value of 99.8% (95% confidence interval 13.78-19.18, p=0.0001).Conclusion:Pulse oximetry was found to be easy, safe, sensitive, and highly specific for diagnosis of CCHD.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of the critical congenital heart disease screening program for early diagnosis of cardiac abnormalities in newborn infants

Almawazini

Hanafi

Madkhali

et al. 2017

SMJ

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“…The level of readiness of each state and NBN to successfully implement this screening is unknown and likely varies widely from state to state and between hospitals within the same state. 6 The Minnesota Department of Health (MDH) adopted implementation of newborn screening for CCHD in August 2012. Since October 2009, MDH has partnered with medical professionals including faculty at the University of Minnesota, local hospitals, and patient advocates to develop this program.…”

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confidence: 99%

Implementation of Critical Congenital Heart Disease Screening in Minnesota

Kochilas¹,

Lohr²,

Bruhn³

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Pulse oximetry screening at 24 hours of age improves detection of critical congenital heart disease in asymptomatic newborns. WHAT THIS STUDY ADDS:This study describes an initial experience with pulse oximetry screening for critical congenital heart disease and provides a strategy for preparing for state implementation of recent federal newborn screening recommendations. abstract OBJECTIVE: To assess the level of preparedness and resources needed in Minnesota for the implementation of newborn screening for critical congenital heart diseases (CCHDs). METHODS:A cross sectional survey of all birth centers in Minnesota was performed to assess the capacity to deliver care essential for the CCHD screening program. Compliance with the screening algorithm, nursing workload, and cost were assessed by using a pilot program implemented in 6 normal newborn nurseries.RESULTS: Ninety-one of 99 eligible centers participated in the survey and 90 reported the ability to screen newborns in accordance with recommendations. Only 22 centers, with 63% of births, had access to echocardiography and routinely stocked prostaglandins for neonatal use. Our pilot study screened 7549 newborns with 6 failed screens and 1 CCHD diagnosis. Two of the failed screens were due to misinterpretation of the algorithm, 1 failed screen was not reported, and 4 failed screens were not recognized. Repeated screens were required for 115 newborns, with 29% of retesting due to misinterpretation of the algorithm. The mean nursing time required was 5.5 minutes, and the cost was $5.10 per screen. CONCLUSIONS:In Minnesota, two-thirds of newborns are born in centers with resources for initial diagnosis and management of CCHD. Implementation of a pilot screening program demonstrated minimal increase in nursing workload, but identified problems with interpretation of the algorithm and data reporting. This pilot project suggests the need for simplification of the algorithm, additional training of health care providers, and development of a centralized reporting mechanism. Pediatrics 2013;132:e587-e594

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“…11 Newborns with undetected CCHD are discharged from hospitals as "healthy" only to return via the emergency department after becoming symptomatic at home such as poor feeding and/or cyanosis and apnea, or with more critical events such as heart failure or cardiogenic shock. 13 In most cases of CCHD, the patent ductus arteriosus is the only way that oxygenated blood can mix with deoxygenated blood and it will need to remain open after birth. 13 In most cases of CCHD, the patent ductus arteriosus is the only way that oxygenated blood can mix with deoxygenated blood and it will need to remain open after birth.…”

Section: Background and Significancementioning

confidence: 99%

Screening for Critical Congenital Heart Disease in Newborns Using Pulse Oximetry

Ryan¹,

Mikula²,

Germana³

et al. 2014

Advances in Neonatal Care

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A retrospective review of admission preductal oxygen saturations of neonates with antenatally diagnosed critical congenital heart disease (CCHD) was performed to investigate the differences in newborn pulse oximetry (Pulsox) by specific CCHD diagnosis. Saturations were recorded at median of < 1 h (range < 1-9 h) after delivery. Data was stratified by CCHD diagnosis and analysed according to the three different admission Pulsox thresholds, ≤ 90, ≤ 92 and ≤ 95%. Of the 276 neonates studied, 208 were clinically well at admission, with no co-morbidities, gestation > 34 weeks and birth weight > 1.8 kg. A statistically significant increase in the proportion with low admission saturations was seen using ≤ 95% saturation threshold (72% (95% CI 66-78)) compared to ≤ 92% (52% (95% CI 46-59)) and ≤ 90% (46% (95% CI 39-52)). Subgroup analysis found the proportion of neonates with low saturations varied according to the specific CCHD diagnosis with only 20-42% of neonates with aortic stenosis, coarctation of the aorta and pulmonary stenosis having saturations ≤ 95%. Conclusion: The proportion of neonates with low admission oxygen saturation varied by CCHD diagnosis with those without critically reduced pulmonary blood flow not having low admission saturations, in general, even using the ≤ 95% threshold which had the highest proportions of abnormal saturations. This data may assist developing Pulsox screening policies. What is Known: • The addition of pulse oximetry (Pulsox) screening to the routine newborn examination increases the sensitivity of CCHD detection. Pulsox screening is also highly specific for CCHD in asymptomatic neonates, with low false-positive rates. • Early diagnosis of CCHD improves patient outcomes in relation to both morbidity and mortality. What is New: • The proportion of affected infants with an abnormal Pulsox result varies by CCHD diagnosis and screening threshold. In our study using the ≤ 95% threshold gave the highest proportion of neonates with abnormal saturations at admission. • In general, Pulsox yield of abnormal results is low for CCHD diagnoses not associated with critically reduced pulmonary blood flow; however, increasing the Pulsox threshold increased the proportion of infants with an abnormal result.

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The Road to Universal Pulse-Oximetry Screening: Are We There Yet?

Cited by 9 publications

References 12 publications

Effectiveness of the critical congenital heart disease screening program for early diagnosis of cardiac abnormalities in newborn infants

Effectiveness of the critical congenital heart disease screening program for early diagnosis of cardiac abnormalities in newborn infants

Implementation of Critical Congenital Heart Disease Screening in Minnesota

Screening for Critical Congenital Heart Disease in Newborns Using Pulse Oximetry

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