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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2015, Number 2

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Rev Invest Clin 2015; 67 (2)

Pulse Oximetry as a Screening Test for Critical Congenital Heart Disease in Term Newborns

Gómez-Rodríguez G, Quezada-Herrera A, Amador-Licona N, Carballo-Magdaleno D, Rodríguez-Mejía EJ, Guízar-Mendoza JM

Language: English
References: 32
Page: 130-134
PDF size: 173.86 Kb.


ABSTRACT

Background: Pulse oximetry has been suggested as a screening test for congenital heart disease (CHD) in asymptomatic newborns. However, most newborns in Mexico are discharged from the hospital without this evaluation. Objective: To evaluate pulse oximetry as a screening test for critical congenital heart disease (CCHD) in term newborns. Methods: We conducted a cross-sectional study in term newborns between July 2010 and April 2011. Pulse oximetry was determined before hospital discharge; in case of post-ductal oxygen saturation < 95%, a Doppler echocardiogram was performed. Results: From 1,037 newborns screened, two had CCHD, one had pulmonary atresia and ventricular septal defect, and one Ebstein´s anomaly. Minor CHD was present in 10 babies. The overall prevalence of CHD was 11.5 per 1000 live births, and the prevalence of CCHD was 3.9 per 1000 live births. For those with critical disease, pulse oximetry had a sensitivity of 100%, specificity 98.8%, positive predictive value 14.2%, negative predictive value 100%, and positive likelihood ratio of 86.2. In regression analysis, oxygen saturation, respiratory frequency, and postnatal age were related with CCHD. Conclusions: Pulse oximetry had a good sensitivity and specificity for the identification of critical congenital heart disease in term newborns. Low oxygen saturation, higher respiratory frequency, and early postnatal age were related with congenital heart disease.


REFERENCES

  1. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153:807-13.

  2. Castilla EE, Orioli IM. ECLAMC: the Latin-American collaborative study of congenital malformations. Community Genet. 2004; 7:76-94.

  3. Ainsworth S, Wyllie J, Wren C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child-Fetal Neonatal. 1999;80:43-5.

  4. Hallidie-Smith KA. Some auscultatory and phonocardiographic findings observed in early infancy. BMJ. 1960;i:756-9.

  5. Arlettaz R, Archer N, Wilkinson AR. Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child-Fetal Neonatal. 1998;78:F166-70.

  6. Attenhofer Jost CH. [Heart murmur-auscultation or echocardiography in the diagnostic assessment of congenital or valvular heart disease?]. Ther Umsch. 2006;63:463-70.

  7. Kamlin CO, Dawson JA, O’Donnell CP, et al. Accuracy of pulse oximetry measurement of heart rate of newborn infants in the delivery room. J Pediatr. 2008;152:756-60.

  8. Rabi Y, Yee W, Yue Chen S, Singhal N. Oxygen saturation trends immediately after birth. J Pediatr. 2006;148:590-4.

  9. Mahle WT, Newburger JW, Matherne GP, et al. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation. 2009;120:447-58.

  10. Richmond S, Reay G, Abu HM. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal. 2002;87:83-8.

  11. Rabi Y, Yee W, Yue Chen S, Singhal N. Oxygen saturation trends immediately after birth. J Pediatr. 2006;148:590-4.

  12. Jubran A. Pulse oximetry. Intensive Care Med. 2004;30:2017-20.

  13. Hoke TR, Donohue PK, Bawa PK, et al. Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study. Pediatr Cardiol. 2002;23:403-9.

  14. Saugstad OD. Oxygen saturations immediately after birth. J Pediatr. 2006;148:569-70.

  15. Tapia-Rombo CA, Rosales-Cervantes MG, Saucedo-Zavala VJ, Ballesteros-del Olmo JC, Sánchez-García L, Santos-Vera I. Peripheral oxygen saturation using pulse oximetry among healthy term newborns at Mexico City’s altitude (2240 m). Gac Med Mex. 2008;144:207-12.

  16. de-Wahl Granelli A, Mellander M, Sunnegardh J, Sandberg K, Östman-Smith I. Screening for duct-dependent congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity. Acta Paediatr. 2005;94:1590-6.

  17. Reich JD, Miller S, Brogdon B, et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr. 2003;142:268-72.

  18. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890-900.

  19. Sipek A, Gregor V, Sipek A Jr. Incidence of congenital heart defects in the Czech Republic-current data. Cska Gynekol. 2010;75:221-42.

  20. Maroto-Monedero C, Camino-López M, Girona-Comas JM, Malo- Concepción P. Clinical practice guidelines of the Spanish Society of Cardiology in congenital heart disease in newborns. Rev Esp Cardiol. 2001;54:49-66.

  21. de-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:a3037.

  22. Arlettaz R, Bauschatz AS, Monkhoff M, Essers B, Bauersfeld U. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr. 2006;165:94-8.

  23. Koppel RI, Druschel CM, Carter T, et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics. 2003;111:451-5.

  24. Peterson C, Ailes E, Riehle-Colarusso T, et al. Late detection of critical congenital heart disease among US infants: Estimation of the potential impact of proposed universal screening using pulse oximetry FREE. JAMA Pediatr. 2014;168:361-70.

  25. Liberman RF, Getz KD, Lin AE, et al. Delayed diagnosis of critical congenital heart defects: Trends and associated factors. Pediatrics. 2014;134:e373-81.

  26. Niederbacher-Velásquez J, García-Niño M, Gómez-Moya G. [Reference values of arterial oxygen saturation by pulse oximetry in healthy children from Bucaramanga]. MedUNAB. 2003;6:63-9.

  27. Jing ZC, Xu XQ, Badesch DB, et al. Pulmonary function testing in patients with pulmonary arterial hypertension. Respir Med. 2009;103:1136-42.

  28. Pianosi PT, Johnson JN, Turchetta A, Johnson BD. Pulmonary function and ventilatory limitation to exercise in congenital heart disease. Congenit Heart Dis. 2009;4:2-11.

  29. Meberg A, Brügmann-Pieper S, Due R, et al. First day of life pulse oximetry screening to detect congenital heart defects. J Pediatr. 2008;152:761-5.

  30. Frank LH, Bradshaw E, Beekiman R, Mahle WT, Martin GR. Critical congenital heart disease screening using pulse oximetry. J Pediatr. 2013;162:445-53.

  31. 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.

  32. Ewer AK, Furmton AT, Middleton LJ, et al. Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and costeffectiveness. Health Technol Assess. 2012;16:v-xiii 1-184.




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