Role of Pulse Oximetry Screening for Detection of Life Threatening Congenital Heart Detects in Newborn

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Aso Faeq Salih Adnan Mohammed Hamawand Riyadh Abd Aljabbar Sattar


Most ofnewborns with Congenital Heart Defects (CHDs) can be detected by using echocardiography. However, if such defects are not diagnosed in earlier time, therefore a severe hypoxemia, shock, acidosis and death are considered of some potential sequelae. A prospective study from January 2012 to the end of 2013 was performed and 2181 neonates were enrolled in the study. The pulse oximetry screening (POS) for both hands and one foot were obtained within the first 3-6 hours of life, when post ductal saturation was below 90%, it was considered as a positive screening, while when the saturation is between 90-95% and the difference between pre-and post-ductal saturation was more than 3%, the baby was provisionally considered to be screening as a positive then echocardiography is planned. Among 100 positive POS babies, 45 (45%) of them were detected with CHS, 12 (12%) was with a major CHS and 33 (33%) was with a minor CHS. Out of 12 patients with a major CHD 6 of them (50%) were asymptomatic at the time of POS.POS result was a true negative in 2078 patients, a true positive in 45 patients, false negative in 3 patients, and false positive in 55 and 28/55 of the false positive rate with POS had other pathology. The false positive rate with pulse oximetry screening is (55/2081) = 0.26%. Sensitivity, specificity, positive and negative predictive value for POS in detection of major CHD were 80%, 97.29%, 17.9% and 99.80%, respectively. Pulse oximetry screening is significantly improving the detection of life threatening congenital heart disease at an early stage.


Pediatrics, Pulse Oximetry, Congenital Heart Defects, Newborn.


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[1] D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, TB. Ferguson, K. Flegal, et al., “Heart disease and stroke statistics 2009 update: a report from the American Heart AssociationStatistics Committee and Stroke Statistics Subcommittee,” Circulation, 119, pp. e21–181, 2009.
[2] C. Wren, Z. Reinhardt, K. Khawaja, “Twenty-year trends in diagnosis of life-threatening neonatal cardiovascuar malformations,” Arch Dis Child Fetal Neonatal Ed, 93, pp. F33–5, 2008.
[3] R, Knowles, I, Griebsch, C, Dezateux, J, Brown, C. Bull, C. Wren, “Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis,” Health TechnolAssess, 9(44), pp. 115-18, 2005.
[4] JIE. Hoffman, S. Kaplan, “The incidence of congenital heart disease,” J Am CollCardiol, 39, pp. 1890–900, 2002.
[5] C. Wren, S. Richmond, L. Donaldson, “Temporal variability in birth prevalence of cardiovascular malformations,” Heart, 83, pp. 414–19, 2000.
[6] T. Tikanoja, “Effect of technical development on the apparent incidence of congenital heart disease,” Pediatric Cardiol,16, pp. 100–1, 1995.
[7] [7] WT. Mahle, JW. Newburger, GP. Matherne, FC. Smith, TR. Hoke, R. Koppel, et al., “Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP,” Pediatrics, 124, pp. 823–36, 2009.
[8] SC. Mitchell, SB. Korones, HW. Berendes, “Congenital heart disease in 56,109 births incidence and natural history,” Circulation, 43, pp. 323–32, 1971.
[9] KJ. Barrington, “Neonatal screening for life threatening congenital heart disease,” BMJ, 338, pp. 117–18, 2009.
[10] S. Richmond, G. Reay, M. Abu Harb, “Routine pulse oximetry in the asymptomatic newborn,” Arch Dis Child Fetal Neonatal Ed, 87, pp. F83–8, 2002.
[11] M. Abu-Harb, E. Hey, C. Wren, “Death in infancy from unrecognized congenital heart disease,” Arch Dis Child, 71, pp. 3–7, 1994.
[12] M. Mellander, J. Sunnegardh, “Failure to diagnose critical heart malformations in newborns before discharge: an increasing problem?,” ActaPaediatrica, 95, pp. 407–13, 2006.
[13] CPF. O’Donnell, COF. Kamlin, PG. Davis, JB. Carlin, CJ. Morley, “Clinical assessment of infant colour at delivery,” Arch Dis Child Fetal Neonatal Ed, 92, pp. F465–7, 2007.
[14] WT. Mahle, “Physical examination and pulse oximetry in newborn infants: out with the old, in with the new?,” J Pediatrics, 152, p.. 747–8, 2008.
[15] P. Valmari, “Should pulse oximetry be used to screen for congenital heart disease?,” Arch Dis Child Fetal Neonatal Ed, 92, pp. F219–24, 2007.
[16] B. Toth, A. Becker, B. Seelbach-Gobel, “Oxygen saturation in healthy newborn infants immediately after birth measured by pulse oximetry,” Arch GynecolObstet, 266, pp. 105–7, 2002.
[17] AF. Bakr, HS. Habib, “Combining pulse oximetry and clinical examination in screening for congenital heart disease,” Pediatric Cardiol, 26, pp. 832–5, 2005.
[18] TR. Hoke, PK. Donohue, PK. Bawa, RD. Mitchell, A. Pathak, PC. Rowe, et al., “Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study,” Pediatric Cardiol, 23, pp. 403–9, 2002.
[19] RI. Koppel, C. Druschel, T. Carter, B. Goldberg, P. Mehta, R. Talwar, et al., “Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns,” Pediatrics, 111, pp. 451–5, 2003.
[20] J. Reich, S. Miller, B. Brogdon, J. Casatelli, T. Gompf, J. Huhta, et al., “The use of pulse oximetry to detect congenital heart disease,” J Pediatrics, 142, pp. 268–72, 2003.
[21] A. de Wahl Granelli, M. Mellander, J. Sunnegardh, K. Sandberg, I. Ostman-Smith, “Screening for duct-dependant congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity,” ActaPaediatr, 94, pp. 1590–6, 2005.
[22] E. Rosati, G. Chitano, L. Dipaola, C. De Felice, G. Latini, “Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease,” J Perinat Med, 33, pp. 455–7, 2005.
[23] DM. Sendelbach, GL. Jackson, SS. Lai, DE. Fixler, EK. Stehel, WD. Engle, “Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects,” Pediatrics, 122, pp. e815–20, 2008.
[24] A. Meberg, S. Brugmann-Pieper, D. Reidar, L. Eskedal, I. Fagerli, T Farstad, et al., “First day of life pulse oximetry screening to detect congenital heart defects,” J Pediatr, 152, pp. 761–5, 2008.
[25] A. de Wahl Granelli, M. Wennergren, K. Sandberg, M. Mellander, C. Bejlum, L. Inganas, et al., “Impact of pulse oximetry screening on detection of duct dependent congenital heart disease:a swedish prospective screening study in 39 821 newborns,” BMJ, 338, pp. A3037, 2009.
[26] R. Arlettaz, A. Bauschatz, M. Mankhoff, B. Essers, U. Bauersfeld, “The contribution of pulse oximetry to the early detection of congenital heart disease in newborns,” Eur J Pediatrics, 165, pp. 94–8, 2006.
[27] AR, Kanper, WT. Mable, GR. Martin, WC. Cooley, P. Komer, WR. Marrow, et al., “Stratigies for implimentation screening for critical congenetal heart disease,” pediatrics, 128, pp. C 1259. 2011.
[28] F. Riede, I. Dähnert, C. Woerner, A. Moeckel, N. Lorenz, M. Kabus, et al., “Reduction of the diagnostic gapin critical congenital Heart defects by Puls oxymetrie screening,” Monatsschr Kinderheilkd, 157, pp. 896-902, 2009.
[29] A.F. BAKR and H.S. HABIB, “Combining pulse oximetry and clinical examination in screening for congenital heart disease,” Pediatr Cardiol, 26, pp. 832-5, 2005.
[30] V. Balu, M. Gayathry, TH. Sinimol, R. Karimaserry, and K. Karukappilly, “Clinical Screening for Congenital Heart Disease at Birth: A Prospective Study in a Community Hospital in Kerala,” springer, 33, pp. 2Fs 13312-011, 2002.
[31] A. Mohamed, EL. Hatem, B. ALDeek, and B. Safiyaa, “Can Pulse Oximetry Screening Reduce the Postnatal Diagnostic Gap in Critical Congenital Heart Diseases?,” Med. J. Cairo Univ., 80, pp. 93-99, 2012.
[32] Th. Frank, W. Cornelia, D. Ingo, M. Andreas, K. Martin, S. Peter, “Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine—results from a prospective multicenter study,” J. Perinat. Med., 33, pp. 455-7, 2005.