Newborn Pulse Oximetry Screening: Which Algorithm Is Best?

Abstract

* Abbreviations: FP — : false positive POS — : pulse oximetry screening CCHD — : critical congenital heart defect Pulse oximetry screening (POS) is an accepted test that improves detection of critical congenital heart defects (CCHD).1 Although outcome data are lacking, there is agreement among clinicians that POS identifies infants with CCHD before discharge. After consideration by an expert workgroup, POS was adopted onto the US Recommended Uniform Screening Panel,2 and other countries have either introduced, or are considering introducing, POS.1 Despite this, there is considerable variation in screening, particularly the algorithm used.3 Differences include (1) pre- and postductal saturations (right hand and either foot) versus single postductal measurement (foot only) and (2) timing of screening (ie, before or after 24 hours). In algorithms using 2 limb measurements, there are also differences: inclusion of saturations <95% in 1 or both limbs and the absolute value of the differential between the 2 in determining positive results.1 So which algorithm is best? When evaluating algorithms, it is important to consider sensitivity, specificity, false-positive (FP) and false-negative rate. It is also vital that screening leads to timely diagnosis (ie, before presentation with acute collapse). Meta-analysis of POS studies shows that overall, the test has moderate sensitivity (∼75%) and high specificity (99.8%), with no significant difference in sensitivity between pre/–post versus postductal testing or timing.3 However, analysis of raw saturation data from infants who had both limb measurements shows that some infants with CCHD would be missed by postductal testing alone.1 In addition, the FP rate is significantly higher with earlier testing (<24 hours).3 These factors were deemed … Address for correspondence Andrew K. Ewer, Neonatal Unit, Birmingham Women’s Hospital, Edgbaston, Birmingham UK. B15 2TG. E-mail: a.k.ewer{at}bham.ac.uk