Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease
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Enrico Rosati
Abstract
Aims: Critical congenital cardiovascular malformations (CCVMs) require surgical correction during the first month of life, physical examination is unable to detect >50% of affected infants. An oximetry screening has been previously proposed. Our aim was to verify the usefulness and consistency of a pulse oximetry screening for early detection of CCVMs in a small size nursery.
Methods: A single determination of SpO2 was performed on 5292 consecutive apparently healthy newborns, discharged from nursery at a median age of 72 h during the period May 1, 2000 and November 30, 2004. Infants showing signs of congenital heart disease before the screening and those with a prenatal diagnosis were excluded. Cardiac ultrasound was performed on all infants with SpO2≤95% at >24 h. The accuracy of the screening in identifying CCVMs was assessed by receiver-operating characteristic (ROC) curves analysis.
Results: We found 2 (0.038%) true positives, 1 (0.019%) false negative, 1 (0.019%) false positive, and 5288 (99.92%) true negatives. Prevalence of critical CCVMs was 1 in 1764. Clinical follow-up showed no evidence of CCVMs in the negative cases. A pulse-oximetry cut-off value of ≤95% showed 66.7% sensitivity (95% CI: 11.6–94.5), 100% specificity (95% CI: 99.9–100.0), 50% positive predictive value, 100% negative predictive value and AUC of 0.833 (standard error: 0.145) (95% CI: 0.823 to 0.843) in identifying CCVMs.
Conclusions: Our findings indicate that pulse oximetry is a non-invasive and specific screening tool for an early detection of CCVMs, and is easily applicable to a small size nursery.
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©2005 by Walter de Gruyter Berlin New York
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- The best marker combination using the integrated screening test approach for detecting various chromosomal aneuploidies
- Effects of arecoline in relaxing human umbilical vessels and inhibiting endothelial cell growth
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- Special relationships between fetal inflammatory response syndrome and bronchopulmonary dysplasia in neonates
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- Variability in pain expression characteristics in former preterm infants
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- Intracervical application of synthetic hydrogel sealant for preterm prelabor rupture of membranes: a case report
- Gender dependent association between perinatal morbidity and estrogen receptor-alpha Pvull polymorphism
- Neonatal length and cranial circumference are reduced in human pregnancies at term after antepartum administration of betamethasone
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