Oxygen Saturation and Perfusion Index-Based Enhanced Critical Congenital Heart Disease Screening

Objective To determine if addition of perfusion index (PIx) to oxygen saturation (SpO2) screening improves detection of critical congenital heart disease (CCHD) with systemic outflow obstruction. Study Design We determined screening thresholds for PIx and applied these to a cohort of newborns with and without congenital heart disease (CHD). Results A total of 123 normal and 21 CHD newborns (including five with critical systemic outflow obstruction) were enrolled. Four of these five critical systemic obstruction subjects passed SpO2-based screen. Four out of these five subjects failed PIx-based screen. The sensitivity for detection of systemic obstruction CCHD when compared with healthy infants increased from 20% (95% confidence interval [CI]: 1–72%) with SpO2 screening alone to 80% (95% CI: 28–100%) with combined SpO2-PIx screen. However, 2.44% of normal infants failed PIx screen. Conclusion Addition of PIx to SpO2 screening may detect additional cases of CCHD and further research is necessary to come up with optimal screening thresholds.

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Perfusion index in healthy newborns during critical congenital heart disease screening at 24 hours: retrospective observational study from the USA

BMJ Open ◽

10.1136/bmjopen-2017-017580 ◽

2017 ◽

Vol 7 (12) ◽

pp. e017580 ◽

Cited By ~ 5

Author(s):

Priya Jegatheesan ◽

Matthew Nudelman ◽

Keshav Goel ◽

Dongli Song ◽

Balaji Govindaswami

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Observational Study ◽

Oxygen Saturation ◽

Congenital Heart ◽

Selection Method ◽

Perfusion Index ◽

Data Selection ◽

Retrospective Observational Study ◽

Critical Congenital Heart Disease

ObjectiveTo describe the distribution of perfusion index (PI) in asymptomatic newborns at 24 hours of life when screening for critical congenital heart disease (CCHD) using an automated data selection method.DesignThis is a retrospective observational study.SettingNewborn nursery in a California public hospital with ~3500 deliveries annually.MethodsWe developed an automated programme to select the PI values from CCHD screens. Included were term and late preterm infants who were screened for CCHD from November 2013 to January 2014 and from May 2015 to July 2015. PI measurements were downloaded every 2 s from the pulse oximeter and median PI were calculated for each oxygen saturation screen in our cohort.ResultsWe included data from 2768 oxygen saturation screens. Each screen had a median of 29 data points (IQR 17 to 49). The median PI in our study cohort was 1.8 (95% CI 1.8 to 1.9) with IQR 1.2 to 2.7. The median preductal PI was significantly higher than the median postductal (1.9 vs 1.8, p=0.03) although this difference may not be clinically significant.ConclusionUsing an automated data selection method, the median PI in asymptomatic newborns at 24 hours of life is 1.8 with a narrow IQR of 1.2 to 2.7. This automated data selection method may improve accuracy and precision compared with manual data collection method. Further studies are needed to establish external validity of this automated data selection method and its clinical application for CCHD screening.

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Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease

PEDIATRICS ◽

10.1542/peds.2012-3320 ◽

2013 ◽

Vol 131 (6) ◽

pp. e1803-e1810 ◽

Cited By ~ 16

Author(s):

P. Jegatheesan ◽

D. Song ◽

C. Angell ◽

K. Devarajan ◽

B. Govindaswami

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Oxygen Saturation ◽

Congenital Heart ◽

Critical Congenital Heart Disease

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Perfusion index cannot be currently recommended as an additional newborn screen for critical congenital heart disease: more data needed

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316515 ◽

2019 ◽

Vol 104 (5) ◽

pp. 411-412 ◽

Cited By ~ 1

Author(s):

Andrew K Ewer

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Perfusion Index ◽

Critical Congenital Heart Disease ◽

Newborn Screen

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Oxygen saturation among newborns in the first 10 hours of life to detect Critical Congenital Heart Disease - Ductus Dependent

Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya ◽

10.30651/jqm.v4i2.4258 ◽

2020 ◽

Vol 4 (2) ◽

pp. 237

Author(s):

Fatchul Wahab ◽

Mahrus Abdul Rahman ◽

Teddy Ontoseno ◽

Risa Etika ◽

Alit Utamayasa ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Oxygen Saturation ◽

Pulse Oximetry ◽

Gold Standard ◽

Congenital Heart ◽

Critical Congenital Heart Disease ◽

Exact Test ◽

Consecutive Sampling ◽

The Right

ABSTRACT Delay diagnosis of Critical Congenital Heart Disease (CHD) can be associated with sudden clinical deterioration and dangerous cardiovascular conditions. The oxygen saturation screening among newborns in the first 10 hours of life is essential for early detection of critical CHD. This study aims to prove that measuring oxygen saturation among newborns in the first 10 hours of life can detect critical CHD. This study is a diagnostic experimental with consecutive sampling subjects in the infant care unit of Dr. Soetomo Hospital, including all newborns with birth weight ≥ 1500 grams and oxygen saturation at ≥ 1 hour of age below 90%. The measurement of oxygen saturation uses fingertip pulse oximetry in the right hand and foot at the age of 10 hours. A "positive oxygen saturation" is defined as oxygen saturation ≤ 85% or different oxygen saturation ≥ 3%, while a "negative oxygen saturation" is when the oxygen saturation is 85% to 90% or different oxygen saturation is 3%. Echocardiography is performed for the gold standard. From November 2019 to January 2020, 11 newborns underwent an oxygen saturation examination. Five subjects (45.46%) in the category of positive oxygen saturation, echocardiographic showed all Critical CHD (100%). Six subjects (54.54%) with negative oxygen saturation category, echocardiographic results showed two critical CHD (33.34%) and four non-critical CHD (66.66%). Fisher's exact test p < 0.005 (α). The diagnostic oxygen saturation test among newborns at 10 hours of life shows ≤85%, all subject’s echocardiography (100%) shows detection of critical CHD, while saturation 85% to 90% has of 33.3% for detection of critical CHD. The sensitivity and specificity of oxygen saturation for early diagnosis of critical CHD are 100% and 67%, respectively. Keywords: critical congenital heart disease, oxygen saturation, fingertip pulse oximetry, diagnostic tests*Corresponding Author: [email protected]

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Lower Oxygen Saturation Threshold (< 93% vs. 95%) for Critical Congenital Heart Disease Screening at High Altitude Prevents False Positives

10.1542/peds.147.3_meetingabstract.401-a ◽

2021 ◽

Author(s):

Heather Siefkes ◽

M Rhonda Sneeringer ◽

Pranjali Vadlaputi ◽

Nicki Naylor ◽

Satyan Lakshminrusimha

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Oxygen Saturation ◽

High Altitude ◽

Congenital Heart ◽

Disease Screening ◽

False Positives ◽

Critical Congenital Heart Disease ◽

Lower Oxygen ◽

Saturation Threshold

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Association between oxygen saturation and critical congenital heart disease in newborns

Paediatrica Indonesiana ◽

10.14238/pi58.2.2018.90-4 ◽

2018 ◽

Vol 58 (2) ◽

pp. 90-4

Author(s):

Lidia Halim ◽

Muhammad Ali ◽

Tiangsa Sembiring

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Oxygen Saturation ◽

Pulse Oximetry ◽

Congenital Heart ◽

Screening Program ◽

Screening Method ◽

Cross Sectional Study ◽

Critical Congenital Heart Disease ◽

Cross Sectional

Background Critical congenital heart disease (CCHD) is relatively common, with a prevalence of 6-8 in every 1,000 live births. This congenital anomaly is a newborn condition that would be ideally suited for a screening program, if simple and reliable methods were available. Pulse oximetry (PO) has been proposed as a screening method to detect CCHD. Objective To assess for a possible association between decreased oxygen saturation and CCHD in newborns. Methods We conducted a cross-sectional study from March 2014 to February 2015 in several hospitals in North Sumatra. Healthy, full term and post-term newborns aged 2 to 72 hours underwent pulse oximetry measurements on the right hand and one of the lower extremities. If oxygen saturation (SpO2) was ≤ 95%, the measurement was repeated 2 more times. Subjects also underwent echocardiography. Results A total of 386 newborns underwent SpO2 measurements: 377 newborns had SpO2 > 95% and 9 newborns had SpO2 ≤ 95%. Of the infants with SpO2 > 95%, 297 were excluded because their parents refused echocardiography examination. Thus, 80 newborns with SpO2 > 95% and 9 newborns with SpO2 ≤ 95% underwent echocardiography. Echocardiography revealed that 5 of 9 newborns with SpO2 ≤ 95% suffered from Tetralogy of Fallot (ToF) (3 subjects) and transposition of the great arteries (TGA) (2 subjects). One infant with SpO2 > 95% had ventricular septal defect (VSD), as detected by echocardiography. Oxygen saturation ≤ 95% had significant association with CCHD (P<0.001). Conclusion Decreased oxygen saturation has a significant association with critical congenital heart disease in newborns.

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