Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis

Abstract

Objective: This study assessed the performance of pulse oximetry as a screening method for the detection of critical congenital heart defects (CHD) in asymptomatic newborn babies. Background: Screening for critical congenital heart defects in newborn babies can aid in early recognition, which may lead to improved outcome. The potential predictive value of using pulse oximetry to screen for significant cyanotic CHD in newborns has been unclear. One difficulty of determining the potential value of universal screening of newborns with pulse oximetry from previous studies is that the relative infrequency of CHD made any individual study less able to demonstrate benefit. This meta-analysis with 229,421 newborn babies makes this a more powerful study. Methods: In this meta-analysis, the authors searched Medline (1951–2011), Embase (1974–2011), Cochrane Library (2011), and SciSearch (1974–2011) for studies that assessed the accuracy of pulse oximetry for the detection of critical CHD in asymptomatic newborn babies. Two reviewers selected studies that met the predefined criteria for population, tests, and outcomes, and sensitivity, specificity, and corresponding 95% CIs for individual studies were determined. Results: This meta-analysis identified 13 studies, published from 2001 to 2011, that screened 229,421 asymptomatic newborn infants for critical CHD (defined as disorders from which infants died or required invasive procedures or surgery in the first 28 days of life). The overall sensitivity of pulse oximetry for detection of critical CHD was 76.5%. The specificity was 99.9%, with a false-positive rate of 0.14%. Measurement of pulse oximetry before 24 h of age improved sensitivity from 77.5% to 84.8% (a nonsignificant difference) but increased the false-positive rate from 0.05% to 0.5% (a significant difference; p = .0017). Location of the pulse oximeter probe did not affect sensitivity or the frequency of false-positive results. Thangaratinam and colleagues concluded that pulse oximetry is a highly specific test for detection of critical CHD in newborn infants, and that the false-positive rate is low, especially when done after 24 h of age. Conclusion: Pulse oximetry is highly specific and moderately sensitive for detection of critical CHD and it meets the criteria for universal screening.