Screening For Critical Congenital Heart Defects Research Articles

Adapted protocol for pulse oximetry screening for congenital heart defects in a country with homebirths

Pulse oximetry has been recommended for neonatal screening for critical congenital heart defects (CCHD) and is now performed in several countries where most births take place in hospital. However, there is a wide variation in perinatal care in European countries, and studies are now recommended to determine the accuracy and cost-effectiveness of CCHD screening in individual countries. In the Netherlands, a large part of births are supervised by a community-based midwife, at home or at policlinics. A screening protocol has been developed to fit into the Dutch perinatal setting, and also has the potential to increase safety in homebirths. the provided protocol might be useful for other countries that are planning to implement CCHD screening after homebirths or early discharge from hospital.

Smooth Implementation of Critical Congenital Heart Defect Screening in a Newborn Nursery

In January of 2012, University of Arkansas for Medical Sciences began implementation of a critical congenital heart disease screening program to identify newborns with structural heart defects. The screening used motion tolerant pulse oximeters in direct sequence to measure the oxygen levels in the right hand and either foot of eligible newborns. Exclusion criteria included echocardiogram prior to discharge, age greater than 7 days with continuous neonatal intensive care unit monitoring, or death or transfer prior to discharge. Of the 1905 infants screened, 3 infants failed screening. Two of the infants had atrial septal defects, and 1 had a patent foramen ovale, which was considered a false positive. After planning and education, the implementation of critical congenital heart disease pulse oximetry screening was successful. With only 1 false positive in our high-risk population, this should encourage other institutions to begin screening eligible infants.

Review of pulse oximetry screening for critical congenital heart defects in newborn infants

The concept of using pulse oximetry as a screening method to detect undiagnosed critical congenital heart defects (CCHD) in asymptomatic newborns was first explored over 10 years ago. A number of studies were subsequently reported, which initially involved relatively small numbers of patients, low prevalence of CCHD and heterogeneous methodology. As a consequence, the majority of clinicians felt the case for routine pulse oximetry screening had not been proven. In the last 3 years, four European studies reporting the test accuracy of routine pulse oximetry screening, and involving over 150 ,000 babies, have strengthened the argument. A systematic review and meta-analysis of almost 230 ,000 screened babies has also recently been published which reported high specificity, moderate sensitivity and a low false-positive rate. In addition, acceptability to parents and staff, cost-effectiveness and feasibility of implementing screening outside the research context have also been reported. Pulse oximetry screening is a highly specific, moderately sensitive test, which is acceptable to parents and staff, likely to be cost-effective and fulfils the criteria for universal screening. Routine screening for CCHD using pulse oximetry is being increasingly supported and was added to the recommended uniform screening panel in the USA in 2011.