search text   Advanced Search

This Article Full Text Full Text (PDF) P3Rs: Submit a response P3Rs: View responses Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via ISI Web of Science (21) Citing Articles via Google Scholar Google Scholar Articles by Koppel, R. I. Articles by Bierman, F. Z. Search for Related Content PubMed PubMed Citation Articles by Koppel, R. I. Articles by Bierman, F. Z. Related Collections Heart & Blood Vessels

Effectiveness of Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Newborns

Robert I. Koppel, MD^*, Charlotte M. Druschel, MD, MPH, Tonia Carter, MS, Barry E. Goldberg, MD, Prabhu N. Mehta, MD, Rohit Talwar, MD and Fredrick Z. Bierman, MD^*

^* Department of Pediatrics, Schneider Children’s Hospital, New Hyde Park, New York
Department of Health, New York State, Albany, New York
Department of Pediatrics, Good Samaritan Hospital, West Islip, New York

--> Objective. To determine the sensitivity, specificity, predictive value, and accuracy of a program of pulse oximetry screening of asymptomatic newborns for critical congenital cardiovascular malformation (CCVM).

Methods. Pulse oximetry was performed on asymptomatic newborns in the well-infant nurseries of 2 hospitals. Cardiac ultrasound was performed on infants with positive screens (saturation 95% at >24 hours). Data regarding true and false positives as well as negatives were collected and analyzed.

Results. Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases of CCVM were detected (total anomalous pulmonary venous return x2, truncus arteriosus). During the study interval, there were 9 live births of infants with CCVM from a group of 15 fetuses with CCVM detected by fetal echocardiography. Six infants with CCVM were symptomatic before screening. There was 1 false-positive screen. Two infants with negative screens were readmitted (coarctation, hypoplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were nonurgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of critical CCVM among all live births was 1 in 564 and among the screened population was 1 in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive value: 75%; negative predictive value: 99.98%; accuracy: 99.97%).

Conclusions. This screening test is simple, noninvasive, and inexpensive and can be administered in conjunction with state-mandated screening. The false-negative screen patients had lesions not amenable to detection by oximetry. The sensitivity, specificity, and predictive value in this population are satisfactory, indicating that screening should be applied to larger populations, particularly where lower rates of fetal detection result in increased CCVM prevalence in asymptomatic newborns.

Key Words: pulse • oximetry • screening • newborn • heart

Abbreviations: CCVM, congenital cardiovascular malformation • CMR, Congenital Malformations Registry

This article has been cited by other articles:

				D. M. Sendelbach, G. L. Jackson, S. S. Lai, D. E. Fixler, E. K. Stehel, and W. D. Engle Pulse Oximetry Screening at 4 Hours of Age to Detect Critical Congenital Heart Defects Pediatrics, September 1, 2008; (2008) peds.2008-0781v1. [Abstract] [Full Text] [PDF]

				A. H. Schultz, A. R. Localio, B. J. Clark, C. Ravishankar, N. Videon, and S. E. Kimmel Epidemiologic Features of the Presentation of Critical Congenital Heart Disease: Implications for Screening Pediatrics, April 1, 2008; 121(4): 751 - 757. [Abstract] [Full Text] [PDF]

				P. Valmari Should pulse oximetry be used to screen for congenital heart disease? Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F219 - F224. [Abstract] [Full Text] [PDF]

				S. Thangaratinam, J. Daniels, A. K Ewer, J. Zamora, and K. S Khan Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F176 - F180. [Abstract] [Full Text] [PDF]

				M. R. Liske, C. S. Greeley, D. J. Law, J. D. Reich, W. R. Morrow, H. S. Baldwin, T. P. Graham, A. W. Strauss, A. L. Kavanaugh-McHugh, and W. F. Walsh Report of the Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease Pediatrics, October 1, 2006; 118(4): e1250 - e1256. [Abstract] [Full Text] [PDF]

				C Patton and E Hey How effectively can clinical examination pick up congenital heart disease at birth? Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2006; 91(4): F263 - F267. [Abstract] [Full Text] [PDF]

				Screening for Congenital Heart Disease Journal Watch Cardiology, April 11, 2003; 2003(411): 3 - 3. [Full Text]

				Screening for Congenital Heart Disease Journal Watch (General), March 25, 2003; 2003(325): 2 - 2. [Full Text]

P³Rs:

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2003 American Academy of Pediatrics. All rights reserved.