Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

N C Gamhewage,Medha Weerasekera,K S Y Perera

doi:10.4038/sljch.v50i4.9890

Abstract

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Highlights

Critical congenital heart disease (CCHD) constitutes a spectrum of different heart anomalies needing intervention early in life for survival[1]
Pulse oximetry screening (POS) was carried out in 8718 babies and was positive in 19 babies; 18 babies had CHD confirmed by echocardiogram, out of which 14 had CCHD
POS demonstrated a positive predictive value (PPV) of 73.7%, and a false positive rate of 0.06%. 1Lecturer in Paediatrics, University of Sri Jayewardenepura, Sri Lanka, 2Medical Officer, Neonatal Intensive Care Unit, Sri Jayewardenepura General Hospital, Sri Lanka, 3Consultant Neonatologist, Neonatal Intensive Care Unit, Sri Jayewardenepura General Hospital, Sri Lanka *Correspondence: nimeshagamhewage@sjp.ac.lk https://orcid.org/0000-0001-5129-4158 (Received on 03 November 2020: Accepted after revision on 18 January 2021)

Summary

Introduction

Critical congenital heart disease (CCHD) constitutes a spectrum of different heart anomalies needing intervention early in life for survival[1]. CCHD accounts for more than 20% of perinatal deaths due to congenital malformations and about 50% of early childhood deaths associated with congenital malformations are known be due to congenital heart disease (CHD)[2]. Especially in developing countries, the hallmark of diagnosing CHD was clinical examination, which included auscultating the praecordium and palpating femoral pulses. It is known that clinical examination alone is not sufficient to identify all forms of CCHD4. This is partly due to increased pulmonary pressure during the early newborn period preventing significant left to right shunts. Studies claim that up to 40% of CCHD could be missed in antenatal assessments, even in developed countries[5]. Pulse oximetry screening (POS) claims to have a sensitivity of 60%, specificity of 99.95%, positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 99.98% in detecting CCHD

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