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Abstract
Despite the progress in the fetal echocardiographic detection of congenital critical heart defects and neonatal physical examination, a significant number of newborn infants are discharged and readmitted to the hospital in severe condition due to cardiac failure or collapse. The aim of this study was to assess the incidence of undetected critical congenital heart disease (CCHD) by a pulse oximetry-screening program in the maternity wards of hospitals with Perinatal Services in a specific geographic area. This is a prospective observational study performed in in the health area corresponding to the city of Valencia. Eligible infants were consecutively admitted newborn infants in the maternities of the participating hospitals with negative fetal echocardiography after normal physical examination in the delivery room. All patients were screened following a specific pulse oximetry protocol before discharge. A total of 8856 newborn infants were screened. A total of three babies presented with severe congenital cardiac malformation and two babies presented with early onset sepsis. Sensitivity was 100% and specificity was 99.97%, with a positive predictive value of 60% and negative predictive value of 100%. Pulse oximetry screening programs in the early neonatal period constitute a valuable tool to avoid inadvertent hospital discharge of severe cardiac malformations and the subsequent life-threatening complications derived.
Highlights
Congenital critical heart defects (CCHD), defined as those needing invasive medical intervention or those that can produce death within the first 30 days after delivery [1], may in many cases exhibit signs and symptoms that develop after hospital discharge, potentially resulting in collapse and death
Upon adding neonatal pulse oximetry screening to prenatal ultrasound detection and postnatal clinical exam, the diagnosis rate of CCHD increases [9] and the undiagnosed cases of CCHD are reduced to less than 10% of total CCHD [10]
It has been estimated that 30% of all CCHD patients have a late diagnosis and could benefit from neonatal screening [16]
Summary
Congenital critical heart defects (CCHD), defined as those needing invasive medical intervention or those that can produce death within the first 30 days after delivery [1], may in many cases exhibit signs and symptoms that develop after hospital discharge, potentially resulting in collapse and death. Prenatal fetal heart ultrasound can detect many such cases, but still some of them can be missed [2]. Both physical examination of the neonate after birth can further detect congenital cardiac malformations, but not all are found [3,4]. Low oxygen saturation can be missed clinically [5,6] Under these circumstances, pulse oximetry appears to be a reliable screening technique in neonates before hospital discharge. Pulse oximetry appears to be a reliable screening technique in neonates before hospital discharge It is simple, noninvasive, low-cost, and very reliable in the detection of hypoxemia, and has been recommended as a screening tool [7,8]. Upon adding neonatal pulse oximetry screening to prenatal ultrasound detection and postnatal clinical exam, the diagnosis rate of CCHD increases [9] and the undiagnosed cases of CCHD are reduced to less than 10% of total CCHD [10]
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