Evaluating the diagnostic value of clinical examination in combination with dual-zone pulse oximetry for diagnosis of critical congenital heart diseases in newborns

Aim. To evaluate the diagnostic significance of clinical examination in combination with pulse oximetry for diagnosis of critical congenital heart disease in newborns in the early neonatal period. Methods. A retrospective analysis of the screening results for dual-zone pulse oximetry in combination with clinical examination in 4201 newborns (2211 girls and 1990 boys) was performed for the period from June 2013 to December 2014. Criteria of inclusion were: healthy full-term neonates (94%) and preterm infants with a gestational age of >34-35 weeks (6%); no signs of diseases that require intensive care at birth; performed pulse oximetry. Results of physical examination, SpO2, echocardiography were examined in newborns with positive test. Diagnostic value of the method for detecting the critical congenital heart defects was evaluated in terms of sensitivity and specificity. Results. In the structure of congenital diseases of the circulatory system, diagnosed in the neonatal period, congenital heart defects, mainly with ductus-dependent hemodynamics, contributed to 19%. The efficiency of critical congenital heart defects timely diagnosis is increasing recently due to prenatal detection (62.5% of cases) and diagnosis in the early neonatal period (87.5% of cases). Screening with dual-zone pulse oximetry performed at 24-48 hours after birth has facilitated the postnatal diagnosis. Positive results of dual-zone pulse oximetry were registered in 10 infants (0.24% of the total number of examined newborns). In 8 cases, echocardiography verified critical congenital heart defects; false-positive test was seen in 2 cases, false-negative test - in 1 case. Conclusion. The specificity of pulse oximetry for diagnosis of severe congenital heart defects in the early neonatal period is very high (99.9 %), the sensitivity is 87.5%, with a small probability of false positives, that allows to consider the dual-zone pulse oximetry as a useful diagnostic method complementary to a thorough clinical examination of the newborn.

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Pulse oximetry screening of critical congenital heart defects in the neonatal period. The Spanish National Neonatal Society recommendation

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2017.06.001 ◽

2018 ◽

Vol 88 (2) ◽

pp. 112.e1-112.e6 ◽

Cited By ~ 1

Author(s):

Manuel Sánchez Luna ◽

Alejandro Pérez Muñuzuri ◽

Ester Sanz López ◽

José Luis Leante Castellanos ◽

Isabel Benavente Fernández ◽

...

Keyword(s):

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Neonatal Period ◽

Heart Defects ◽

Pulse Oximetry Screening

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Clinical Examination and Pulse Oximetry to Detect Congenital Heart Defects

International Journal of Cardiovascular Sciences ◽

10.5935/2359-4802.20150023 ◽

2015 ◽

Vol 28 (2) ◽

Cited By ~ 1

Author(s):

Fernanda Cruz de Lira Albuquerque ◽

Elizabeth Trigueiro Maia ◽

Vanda Lúcia de Figueiredo ◽

Felipe Alves Mourato ◽

Sandra da Silva Mattos

Keyword(s):

Pulse Oximetry ◽

Clinical Examination ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects

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Positive predictive value of pulse oximetry in the screening of critical congenital heart defects in term neonates

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171523 ◽

2017 ◽

Vol 4 (3) ◽

pp. 832

Author(s):

Krithika Damodar Shenoy ◽

Suchetha S. Rao

Keyword(s):

Positive Predictive Value ◽

Pulse Oximetry ◽

Clinical Examination ◽

Congenital Heart Defects ◽

Predictive Value ◽

Congenital Heart ◽

Heart Defects ◽

Term Neonates ◽

Delay In Diagnosis ◽

Pulse Oximetry Screening

Background: Critical congenital heart defects (CCHD) are associated with poor patient outcome due to delay in diagnosis. Clinical examination alone has low positive predictive value (PPV). Pulse oximetry examination is suggested as supplemental screening tool. Aim of this study was to screen term neonates for CCHD by clinical and pulse oximetry evaluations and estimate their PPV separately and combined.Methods:Cross-sectional study of 278 term neonates weighing ≥2500g excluding those with antenatal diagnosis of congenital heart defects and/or requiring intensive care. Sample size calculated using EpiInfo version 7 taking 20,000 as population size, 7% expected frequency, 5% confidence limits and 99.9% confidence level. Ethical clearance and informed consent obtained. Clinical examination was performed within 24 hours of life followed by pre-ductal and post-ductal oxygen saturation (SpO2) recording, using standardized hand-held probe, between 24-48 hours. Neonates categorized as screen positive or negative based on an adapted algorithm. Screen positives were confirmed by echocardiography. SPSS version 16 was used for statistical analysis.Results: Mean age at clinical examination was 7.72 ± 0.32 hours during which none screened positive. Mean age at SpO2 screening was 31.93 ± 0.32 hours and a single non-syndromic, acyanotic male newborn, weighing 2550g screened positive. He was found to have severe pulmonary outflow obstruction, with ductus-dependent flow on echocardiography. PPV for pulse oximetry screening alone was 100%.Conclusions:Ductus dependent lesions missed on clinical examination may be picked up by pulse oximetry screening. Echocardiography may be used selectively to confirm diagnosis on screen positive.

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