Pulse Oximetry Values in Newborns with Critical Congenital Heart Disease upon ICU Admission at Altitude.

John Kim,Christopher Rausch,Merlin Ariefdjohan,Marci Sontag

doi:10.3390/ijns4040030

Abstract

Pulse oximetry screening for critical congenital heart disease (CCHD) has been recommended by the American Academy of Pediatrics (AAP). The objectives of this study are to describe saturation data, and to evaluate the effectiveness of AAP-recommended pulse oximetry screening guidelines applied retrospectively to a cohort of newborns with known CCHD at moderate altitude (5557 feet, Aurora, Colorado). Data related to seven critical congenital heart disease diagnoses were extracted from electronic health records (pulse oximetry, prostaglandin administration, and oxygen supplementation). Descriptive epidemiologic data were calculated. 158 subjects were included in this analysis; the AAP pulse oximetry screening protocol was applied to 149 subjects. Mean pre-ductal and post-ductal pulse oximetry values of the infants known to have CCHD at 24 h of life were 87.1% ± 7.2 and 87.8% ± 6.3, respectively. Infants treated with prostaglandins and oxygen had lower oximetry readings. The screening algorithm would have identified 80.5% of infants with known CCHDs (120/149 subjects). Additionally, sequential pulse oximetry screening based on the AAP-recommended protocol was able to identify a true positive screen capture rate of 80.5% at moderate altitude.

Highlights

Congenital heart disease is among the most common birth defects, with an incidence of approximately 1 per 100 live births
Several Critical congenital heart disease (CCHD) lesions are amenable to identification via pulse oximetry screening, including truncus arteriosus (TA), transposition of the great arteries (TGA), tricuspid valve atresia (TVA), tetralogy of Fallot (TOF), total anomalous pulmonary venous return (TAPVR), hypoplastic left heart syndrome (HLHS), and pulmonary valve atresia with intact ventricular septum (PA/IVS) [6,7,8]
Fifty-six subjects were excluded from data collection due to the following reasons: insufficient pulse oximetry data in the electronic health record (EHR), death prior to 24 h of life, or atrial septostomy or surgery prior to 24 h of life

Summary

Introduction

Congenital heart disease is among the most common birth defects, with an incidence of approximately 1 per 100 live births. Several CCHD lesions are amenable to identification via pulse oximetry screening, including truncus arteriosus (TA), transposition of the great arteries (TGA), tricuspid valve atresia (TVA), tetralogy of Fallot (TOF), total anomalous pulmonary venous return (TAPVR), hypoplastic left heart syndrome (HLHS), and pulmonary valve atresia with intact ventricular septum (PA/IVS) [6,7,8]. Pulse oximetry screening in the first 24–48 h after birth has been found to be highly specific (99.9% specificity; 95% confidence interval (CI) 99.7, 99.9), but with a lower sensitivity of 76.3% (95% CI 69.5, 82.0) in one meta-analysis [9]

Objectives

Methods

Results