Routine Use of Pulse Oximetry in the Newborn to Detect Critical Congenital Heart Disease

Abstract

Critical Congenital Heart Disease’s (CCHD’s) are potentially life-threatening cardiac abnormalities where the systemic or pulmonary circulation is dependent on a patent ductus arteriosus and include those with duct-dependent pulmonary blood flow, inter-circulatory mixing, and systemic hypoperfusion. The seven main CCHD’s screening targets for neonatal pulse oximetry are hypoplastic left heart syndrome, pulmonary atresia (with intact ventricular septum), Tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia and truncus arteriosus. Early diagnosis improves outcomes. Systematic review and metaanalysis of pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies revealed that the overall sensitivity was 76.5% and specificity was 99.9%. The false-positive rate was low when it was done after 24 hours from birth [1]. The American Heart Association and the American Academy of Pediatrics suggest that routine pulse oximetry done on asymptomatic newborns after 24 hours of life but before discharge may detect critical CHD, incurs very low cost, and there is a low risk of harm [2]. European studies suggest that screening is cost-effective in identifying newborns with CCHD [3,4]. Over half of babies discharged with CHD detected in the first year of life were discharged from the hospital with a normal routine neonatal examination and the 6 week exam missed one-third of the patients [5]. In many countries, births are not attended and infants are discharged within hours of birth without medical evaluation by a qualified practioner. CCHD’s will go undetected in this setting.