Newborn Pulse Oximetry Research Articles

PFM.10 Detection of major congenital heart disease (CHD) in babies born at a UK regional perinatal centre

BackgroundCHD is the commonest group of congenital malformations. It has been suggested that the introduction of routine newborn pulse oximetry will improve detection rates of major CHD.AimWe aimed to quantify...

Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact

ObjectiveTo assess whether defined reference ranges of oxygen saturation (SpO2) and heart rate (HR) of term infants after birth also apply for infants born after midwifery supervised uncomplicated vaginal birth,...

Feasibility of Critical Congenital Heart Disease Newborn Screening at Moderate Altitude

Consensus guidelines have recommended newborn pulse oximetry screening for critical congenital heart disease (CCHD). Given that newborn oxygen saturations are generally lower at higher altitudes, the American Academy of Pediatrics and others recommend additional evaluation of the screening algorithm at altitude. Our objective was to evaluate the feasibility of newborn pulse-oximetry CCHD screening at moderate altitude (Aurora, CO; 1694 m). We hypothesized the overall failure rate would be significantly higher compared with published controls. We enrolled 1003 consecutive infants at ≥35 weeks' gestation in a prospective observational study. The nationally recommended protocol for CCHD screening was adhered to with the exceptions of no reflex echocardiograms being performed and providers being informed of results only if saturations were less than predefined critical values. There were 1003 infants enrolled, and 988 completed the screen. The overall failure rate for completed screenings was 1.1% (95% confidence interval: 0.6%-2.0%). The first 500 infants had 1.6% fail, and the last 503 infants had 0.6% fail. Among infants who failed screening, 73% failed secondary to saturations <90%, whereas saturations between 90% and 94%, persistently >3% difference, and multiple criteria were each responsible for 9% of failures. Overall, 1.6% of all infants had incomplete screening and had not passed at the time the test was stopped. Pulse oximetry screening failure rates at moderate altitude are significantly higher than at sea level. Larger studies with alternative algorithms are warranted at moderate altitudes.

Newborn Pulse Oximetry Screening to Detect Critical Congenital Heart Disease

To describe current practice and clarify provider opinion in the US with regard to newborn pulse oximetry screening (NPOx) for critical congenital heart disease. An internet-based questionnaire was forwarded to general pediatricians, neonatologists, and family medicine physicians. Physicians were surveyed regarding involvement in newborn medicine, knowledge of NPOx recommendations, and opinions regarding screening. NPOx protocol specifics were also queried. Survey responses (n = 481) were received with 349 respondents involved in newborn medicine. Forty-nine percent (95% CI 44%-54%) of those involved in newborn medicine practice at a hospital with a NPOx protocol. Sixty-six percent of providers endorsed it as an effective tool, 20% required more education, 11% questioned its sensitivity, and 3% had no opinion. Sixty-five percent of providers were aware of recent state legislation mandating its use and 46% reported awareness of the addition of NPOx to the Recommended Uniform Screening Panel. Eighty-four percent of providers who practice at a hospital without a NPOx protocol were interested in its implementation. NPOx protocols varied and were not uniform with differences in time of test, location of probe, and values considered positive. NPOx has grown in its prevalence and acceptance in clinical practice, yet is far from universal in its application and design despite the recent American Academy of Pediatrics endorsement and its addition to the Recommended Uniform Screening Panel. The majority of physicians involved in newborn medicine deemed it an effective tool.

Results From the New Jersey Statewide Critical Congenital Heart Defects Screening Program

New Jersey was the first state to implement legislatively mandated newborn pulse oximetry screening (POxS) in all licensed birthing facilities to detect critical congenital heart defects (CCHDs). The objective of this report was to evaluate implementation of New Jersey's statewide POxS mandate. A 2-pronged approach was used to collect data on infants screened in all New Jersey birthing facilities from August 31, 2011, through May 31, 2012. Aggregate screening results were submitted by each birthing facility. Data on failed screens and clinical characteristics of those newborns were reported to the New Jersey Birth Defects Registry (NJBDR). Three indicators were used to distinguish the added value of mandated POxS from standard clinical care: prenatal congenital heart defect diagnosis, cardiology consultation or echocardiogram indicated or performed before PoxS, or clinical findings at the time of POxS warranting a pulse oximetry measurement. Of 75,324 live births in licensed New Jersey birthing facilities, 73,320 were eligible for screening, of which 99% were screened. Forty-nine infants with failed POxS were reported to the NJBDR, 30 of whom had diagnostic evaluations solely attributable to the mandated screening. Three of the 30 infants had previously unsuspected CCHDs and 17 had other diagnoses or non-CCHD echocardiogram findings. In the first 9 months after implementation, New Jersey achieved a high statewide screening rate and established surveillance mechanisms to evaluate the unique contribution of POxS. The screening mandate identified 3 infants with previously unsuspected CCHDs that otherwise might have resulted in significant morbidity and mortality and also identified other significant secondary targets such as sepsis and pneumonia.

Correlation of pulse oximetry and apgar scoring in the normal newborns.

Context:Apgar score (AS) is routinely used for assessment of newborns immediately after birth. Within acceptable limits, low saturations at birth are normal in vigorous newborn babies. Various studies have questioned the reliability of AS.Aims:To detect whether AS is an accurate indicator of hypoxemia and to study the correlation of different components of AS with the arterial oxygenation saturation (SpO2) levels of normal newborns in the delivery room.Settings and Design:A prospective cross-sectional observational study on normal healthy neonates delivered vaginally in a tertiary level referral medical college.Materials and Methods:SpO2 levels were monitored continuously in the newborns with a pulse oximeter and serial recording of SpO2 levels was done at 5 min intervals starting at 1 min of life until 30 min after birth. Simultaneously, AS was recorded in these newborns at 1 and 5 min of life.Statistical Analysis:Data was analyzed using the Mann-Whitney–U test.Results:AS at 1 and 5 min of life didn’t correlate with the changes in SpO2 of newborns. In AS; though respiratory efforts and muscle tone were significantly correlated with SpO2 of the newborns, body color did not have significant correlation with simultaneously recorded SpO2.Conclusions:A revised AS in which evaluation of color is replaced by pulse oximetry monitoring would prove to be a better tool for neonatal evaluation in the immediate postnatal period.

Pulse Oximetry Screening for Critical Congenital Heart Defects in Asymptomatic Newborn Babies

Summary Background Screening for critical congenital heart defects in newborn babies can aid in early recognition, with the prospect of improved outcome. We assessed the performance of pulse oximetry as a screening method for the detection of critical congenital heart defects in asymptomatic newborn babies. Methods In this systematic review, we searched Medline (1951–2011), Embase (1974–2011), Cochrane Library (2011), and Scisearch (1974–2011) for relevant citations with no language restriction. We selected studies that assessed the accuracy of pulse oximetry for the detection of critical congenital heart defects in asymptomatic newborn babies. Two reviewers selected studies that met the predefined criteria for population, tests, and outcomes. We calculated sensitivity, specificity, and corresponding 95% CIs for individual studies. A hierarchical receiver operating characteristic curve was fitted to generate summary estimates of sensitivity and specificity with a random effects model. Findings We screened 552 studies and identified 13 eligible studies with data for 229 421 newborn babies. The overall sensitivity of pulse oximetry for detection of critical congenital heart defects was 76·5% (95% CI 67·7–83·5). The specificity was 99·9% (99·7–99·9), with a false-positive rate of 0·14% (0·06–0·33). The false-positive rate for detection of critical congenital heart defects was particularly low when newborn pulse oximetry was done after 24 h from birth than when it was done before 24 h (0·05% [0·02–0·12] vs 0·50 [0·29–0·86]; p=0·0017). Interpretation Pulse oximetry is highly specific for detection of critical congenital heart defects with moderate sensitivity, that meets criteria for universal screening. Funding None.

1741 Pulse Oximetry in Healthy Newborns after Midwifery Supervised Uncomplicated Home Births; Use of International Accepted Percentiles

BackgroundPercentiles of oxygen saturation as a function of time from birth in uncompromised infants born at term are now defined. However, in these percentiles infants born after assisted deliveries (ventouse,...

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

Screening for critical congenital heart defects in newborn babies can aid in early recognition, with the prospect of improved outcome. We assessed the performance of pulse oximetry as a screening method for the detection of critical congenital heart defects in asymptomatic newborn babies. In this systematic review, we searched Medline (1951-2011), Embase (1974-2011), Cochrane Library (2011), and Scisearch (1974-2011) for relevant citations with no language restriction. We selected studies that assessed the accuracy of pulse oximetry for the detection of critical congenital heart defects in asymptomatic newborn babies. Two reviewers selected studies that met the predefined criteria for population, tests, and outcomes. We calculated sensitivity, specificity, and corresponding 95% CIs for individual studies. A hierarchical receiver operating characteristic curve was fitted to generate summary estimates of sensitivity and specificity with a random effects model. We screened 552 studies and identified 13 eligible studies with data for 229,421 newborn babies. The overall sensitivity of pulse oximetry for detection of critical congenital heart defects was 76·5% (95% CI 67·7-83·5). The specificity was 99·9% (99·7-99·9), with a false-positive rate of 0·14% (0·06-0·33). The false-positive rate for detection of critical congenital heart defects was particularly low when newborn pulse oximetry was done after 24 h from birth than when it was done before 24 h (0·05% [0·02-0·12] vs 0·50 [0·29-0·86]; p=0·0017). Pulse oximetry is highly specific for detection of critical congenital heart defects with moderate sensitivity, that meets criteria for universal screening. None.

Abstract 228: A Cost-effectiveness Analysis Of Universal Pulse Oximetry Screening To Detect Critical Congenital Heart Disease In U.s. Newborns

Background and objective: In 2011, critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel for newborns. Most state legislatures have not yet mandated pulse oximetry screening to detect CCHD, and evidence that the screening is cost-effective might be influential in these decisions. This study aimed to estimate the cost-effectiveness of universal newborn pulse oximetry screening for CCHD in the U.S. from the hospital system perspective. Methods: A model was developed to estimate the direct medical costs and health effects of screening all newborns. The health benefits were the number of timely (prior to birth hospital discharge) detected CCHD and life-years saved with the screening compared to existing practice. The analysis focused on ductal-dependent CCHD lesions amenable to pulse oximetry detection. The time horizon was the neonatal period. Costs were not discounted, though future life-years were discounted at 3%. Model inputs related to the epidemiology of CCHD, treatment outcomes, and efficacy of pulse oximetry screening to detect CCHD were derived from published literature. Results: The cost of screening was an estimated $3.83 per newborn, with an incremental cost of $4,693 per life year gained as a result of the screening. Using current U.S. hospital-based births, it was estimated that 248 more cases of CCHD would be identified at birth hospitals and 110 infant deaths averted annually with universal screening. Conclusion: Pulse oximetry screening is a life-saving program and is cost-effective by usual standards of health economic evaluation. The results of this analysis might contribute to policymakers’ decisions on universal pulse oximetry screening and may inform other stakeholders, including health care systems and payers, about likely budget impacts. Further analyses of CCHD hospitalization and screening costs can improve these model estimates.

The Utility of Outpatient Echocardiography for Evaluation of Asymptomatic Murmurs in Children

The purpose of this study is to review sedated outpatient echocardiograms performed to evaluate asymptomatic murmurs in children between the ages of 1 month and 4 years and describe outcomes of tests done to determine if utility varies among age of study and referral type (primary care physician vs. pediatric cardiologist.) We aim to describe the yield in a contemporary cohort which has increased availability and quality of diagnostic aids such as fetal ultrasound, newborn pulse oximetry, and neonatal echocardiography. Retrospective cohort study. Cincinnati Children's Hospital Medical Center: Outpatient Echocardiography Laboratory. Children between 1 month and 4 years of age with asymptomatic murmurs who are referred for outpatient echocardiogram for evaluation of murmur. Primary diagnosis of echocardiography studies, classified into severity score. Results. Four hundred sixty-two sedated echocardiograms were studied. Six (1%) echocardiograms showed severe pathology, and no severe pathology was shown in the echocardiograms ordered at the age of over 6 months old. The yield of studies decreased as age increased. The incidence of abnormal pathology was higher among tests ordered by cardiologists, across all severity levels (P < .0001). Among echocardiograms ordered for children over 1 year of age with an asymptomatic murmur, there was no severe and little moderate disease. Cardiac disease is significantly less likely when echocardiograms are ordered without referral to a pediatric cardiologist. The workup for asymptomatic murmurs does not require an echocardiogram, and these results may aid clinicians when deciding whether evaluation of a child should include this study.

Screening for congenital heart disease with newborn pulse oximetry – Authors' reply

1 Ewer AK, Middleton LJ, Furmston AT, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet 2011; 378: 785–94. to intensive care before screening took place compared with none in our study. We confi rm that all babies in our study were asymptomatic at testing, and the individual case highlighted by OstmanSmith and de-Wahl Granelli was not receiving prostaglandin or oxygen. We disagree that it is impossible to have saturations of 100% and 97% with hypoplastic left heart syndrome. Notably, since the initial examination for this baby was normal, the second test result would have passed according to the protocol described by de-Wahl Granelli and colleagues. We cannot deduce the value of screening where physical examination precedes pulse oximetry from our study, since the results of physical examination are likely to have been aff ected by the prior knowledge of the saturation result. We disagree that all cyanosed babies would be detected clinically, since the ability of clinicians to detect cyanosis is notably poor—in the non-screening regions in de-Wahl Granelli and colleagues’ study, 44% of babies with transposition of great arteries were discharged without diagnosis. Our study, combined with the evidence of others, supports the introduction of routine pulse-oximetry screening for neonates. Introduction of pulseoximetry screening will particularly improve detection rates in regions where antenatal diagnosis rates are lower. The optimum timing of screening requires careful consideration; delayed screening is likely to minimise false-positive rates, whereas earlier screening should improve timely diagnosis.

Screening for congenital heart disease with newborn pulse oximetry

Screening for congenital heart disease with newborn pulse oximetry

Screening for congenital heart disease with newborn pulse oximetry

Andrew Ewer and colleagues (Aug 27, p 785)1Ewer AK Middleton LJ Furmston AT et al.Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study.Lancet. 2011; 378: 785-794Summary Full Text Full Text PDF PubMed Scopus (226) Google Scholar claim that their testing protocol has superior sensitivity to that advocated by de-Wahl Granelli and colleagues.2de-Wahl Granelli A Wennergren M Sandberg K et al.Impact of pulse oximetry screening on the detection of duct-dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns.BMJ. 2009; 338: a3037Crossref PubMed Scopus (311) Google Scholar This claim is incorrect for several reasons. First, Ewer and colleagues' sensitivity figure includes patients known to have critical congenital heart disease by fetal ultrasound scanning. For infants screened blind, as ours were, the sensitivity of Ewer and colleagues' protocol was 58%; our protocol had a sensitivity of 62%.2de-Wahl Granelli A Wennergren M Sandberg K et al.Impact of pulse oximetry screening on the detection of duct-dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns.BMJ. 2009; 338: a3037Crossref PubMed Scopus (311) Google Scholar Second, Ewer and colleagues claim that our protocol would have missed one of their critical cases (prenatally diagnosed hypoplastic left heart syndrome). Our protocol would class the first reading of 92%/97% as abnormal, but the second reading of 100%/97% is impossible in a patient with aortic atresia who is breathing air; presumably he or she was by then receiving prostaglandin infusion and probably oxygen. Ewer and colleagues' protocol results in a significantly lower positive predictive value (9·2%) than does ours (20·7%, 95% CI 12·8–30·7), and a five-times higher false-positive rate (0·85%), with substantial implications for cost and workload; our false-positive rate of 0·17% is low enough to make screening cost-neutral.2de-Wahl Granelli A Wennergren M Sandberg K et al.Impact of pulse oximetry screening on the detection of duct-dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns.BMJ. 2009; 338: a3037Crossref PubMed Scopus (311) Google Scholar, 3Griebsch I Knowles RL Brown J Bull C Wren C Dezateux CA Comparing the clinical and economic effects of clinical examination, pulse oximetry and echocardiography in newborn screening for congenital heart defects: a probabilistic cost-effectiveness model and value of information analysis.Int J Technol Assess Health Care. 2007; 23: 192-204Crossref PubMed Scopus (53) Google Scholar, 4Mahle W Koppel R Screening with pulse oximetry for congenital heart disease.Lancet. 2011; 378: 749-750Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Ewer and colleagues do make some important contributions. Their study confirms earlier findings that incorporation of both preductal and postductal readings, and inclusion of the difference in the screening cutoffs, improves detection rate compared with postductal readings only.2de-Wahl Granelli A Wennergren M Sandberg K et al.Impact of pulse oximetry screening on the detection of duct-dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns.BMJ. 2009; 338: a3037Crossref PubMed Scopus (311) Google Scholar, 5de-Wahl Granelli A Melander M Sunnegardh J Sandberg K Östman-Smith I Screening for duct-dependent congenital heart disease: a critical evaluation of strategies to maximise sensitivity.Acta Paediatr. 2005; 94: 1590-1596Crossref PubMed Google Scholar Second, Ewer and colleagues show that routine pulse-oximetry screening before discharge significantly improves the detection rate of critical congenital heart disease even in health districts that use systematic antenatal cardiac anomaly scanning—a new finding—achieving a total predischarge detection rate of 92%.1Ewer AK Middleton LJ Furmston AT et al.Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study.Lancet. 2011; 378: 785-794Summary Full Text Full Text PDF PubMed Scopus (226) Google Scholar, 2de-Wahl Granelli A Wennergren M Sandberg K et al.Impact of pulse oximetry screening on the detection of duct-dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns.BMJ. 2009; 338: a3037Crossref PubMed Scopus (311) Google Scholar Lastly, the results confirm that screening should ideally be done after the first 6 h of life.1Ewer AK Middleton LJ Furmston AT et al.Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study.Lancet. 2011; 378: 785-794Summary Full Text Full Text PDF PubMed Scopus (226) Google Scholar, 5de-Wahl Granelli A Melander M Sunnegardh J Sandberg K Östman-Smith I Screening for duct-dependent congenital heart disease: a critical evaluation of strategies to maximise sensitivity.Acta Paediatr. 2005; 94: 1590-1596Crossref PubMed Google Scholar We declare that we have no conflicts of interest.

Screening for congenital heart disease with newborn pulse oximetry

Screening for congenital heart disease with newborn pulse oximetry

The Use of Newborn Screening Pulse Oximetry to Detect Cyanotic Congenital Heart Disease: A Survey of Current Practice at Army, Navy, and Air Force Hospitals

To determine the prevalence of newborn screening pulse oximetry (+POx) among military hospitals, including barriers to instituting protocols. An internet-based questionnaire was forwarded to the senior pediatricians at military hospitals worldwide supporting newborn deliveries. Forty seven of 53 hospitals (88%) supporting deliveries responded to the survey. Thirty percent of hospitals utilize a +POx protocol. Eight centers cited no problems with implementation. All hospitals screened at > or = 24 hours of life. The site of recording, positive values, and follow-up for positive screens varied. Cardiology consult and echocardiogram were not mandated. Most hospitals (34/47) are unable to obtain a pediatric cardiology consult without transfer. Few hospitals (9/47) utilize a telemedicine system. Seventy-five percent (24/32) of hospitals not utilizing a protocol are interested in instituting one. Though slightly less than one-third of military hospitals use a +POx, there is a greater interest in its use. More reliable consultative services and a robust telemedicine system may aid its implementation.

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP

The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease

The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.

Pulse oximetry in newborns: What should we use it for and when should we use it?

The use of technology to improve diagnosis is always attractive if it can substantially add to our diagnostic capability. The use of pulse oximetry in newborns, particularly for screening for the presence of congenital heart disease, has been controversial. In this issue of The Journal, two papers and an editorial provide useful information in this debate. Meberg et al reported on the results of a population-based prospective study of pulse oximetry in the first day of life to detect congenital heart defects. They were able to screen over 50 000 live births. Based on their data at the birth and in follow-up, they concluded that pulse oximetry screening is useful in detection of congenital heart diseases and other potentially severe abnormalities. Kamlin et al evaluated the use of pulse oximetry to measure heart rate in newborn infants in the delivery room. They concluded that pulse oximetry provides an accurate measure of heart rate in the newborn. In his editorial, Mahle helps to put these results in perspective. He indicates that both results are potentially useful, but he cautions that pulse oximetry should not give us a false sense of security. Some infants with important congenital heart disease were still missed despite oximetry. False positives were also relatively high. He emphasizes that timing is an important issue for the oximetry measurement. To detect congenital heart disease, the pulse oximetry measurement should probably occur after 24 hours of life, but before hospital discharge. Although, oximetry in the delivery room may have other uses, it is not optimum for congenital heart disease screening.

Normal Values of Pulse Oximetry in Newborns at High Altitude

The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rate, heart rate, and blood pressure in healthy newborns at high altitude. Vital signs and oximetry saturation readings were collected from healthy term newborns at birth, at 1 h, and at 24 h of life. These were analyzed and compared with reference ranges at sea level. This study was carried out at altitudes of 1640 m above sea level in Taif city, Saudi Arabia. A total of 6011 term newborns were examined at birth and 1 h and 4274 were examined at 24 h of life. At birth, the mean SpO(2) was 68.6 per cent and 60.3 per cent from the right upper and lower limbs, respectively. Mean SpO(2) was 94.3 per cent and 95.4 per cent at the age of 1 and 24 h, respectively. These values were significantly lower than those reported at sea level. The mean respiratory rate, heart rate, and mean blood pressure at 24 h were 45.7/min, 149.7/min, and 46.9 mmHg, respectively. It is concluded that pulse oximetry saturation for newborn babies is lower at higher altitudes than at sea level. This effect is observable at altitudes of 1600 m above sea level. Cut-off levels lower than those used at sea level should be adopted when dealing with newborns living at high altitudes.