Role of pulse oximetry in screening of critical congenital heart disease in asymptomatic neonates

Abstract

Background: Neonatal screening for critical congenital heart disease can aid in early recognition and improved outcome of critical congenital heart diseases. Our aim was to assess the performance of pulse oximetry as a screening tool for the detection of critical congenital heart diseases in asymptomatic neonates.Methods: Our study was a hospital based prospective study conducted on all asymptomatic neonates brought to neonatology section of tertiary care hospital. Pulse oximetric screening was performed by a single determination of postductal oxygen saturation in all asymptomatic newborns that fulfilled the inclusion criteria. To ensure universal screening, the timing of pulse oximetric determination was >24 hrs age. All newborns found to have a post-ductal saturation ≤95% underwent additional evaluation by echocardiography. Data regarding true and false positives as well as negatives was collected and sensitivity, specificity and predictive values of pulse oximetry for screening of asymptomatic newborns with congenital heart disease were determined.Results: 2600 neonates were screened and 7 cases of CCHD were diagnosed, giving a prevalence of 0.27 %. Sensitivity, specificity, positive predictive value and negative predictive value of pulse oximetry for detection of CCHD were 77.78%, 99.92%, 77.78% and 99.92%, respectively.Conclusions: We conclude that pulse oximetry is safe, easily available and reasonably accurate for screening of CCHD with sensitivity better than antenatal screening and clinical examination. Its specificity and negative predictive value are very high, making second stage confirmatory echocardiography highly cost-effective. Thus, the results of this study add to the already growing body of evidence that strongly supports introduction of pre discharge pulse oximetry screening as a routine procedure in healthy newborn babies.