scholarly journals Impact of Pulse Oximetry Screening to Detect Congenital Heart Defects: 5 Years’ Experience in a Regional Neonatal Unit in the UK

2021 ◽  
Author(s):  
Yogen Singh ◽  
Si Emma Chen
Keyword(s):  
Clinical Practice ◽  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Newborn Infants ◽  
High Sensitivity ◽  
Neonatal Unit ◽  
Screening Tools ◽  
Pulse Oximetry Screening

Abstract Pulse oximetry screening (POS) has been shown to be an effective and non-invasive investigation that can detect up to 50-70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on the clinical practice. All the eligible newborn infants born between Jan 2015 and Dec 2019 in busy regional neonatal unit were included in the prospective observational study. Of the 25185 eligible infants, 189 (0.8%) infants had a true positive results: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 infants had significant non-cardiac conditions. 43 infants who had a normal POS were later (post-hospital discharge) diagnosed with following category of CHDs: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7% and its specificity was 99.3%. However, its sensitivity for detection of all the major CHDs needing surgery during infancy was 33%.ConclusionPulse oximetry screening showed moderate and high sensitivity in detection of undiagnosed critical CHDs, however it failed to detect two-third of the major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods to detect other major CHDs missed by pulse oximetry screening and other current screening tools.

scholarly journals Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

2021 ◽  
Author(s):  
Yogen Singh ◽  
Si Emma Chen
Keyword(s):  
Clinical Practice ◽  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Newborn Infants ◽  
High Specificity ◽  
Neonatal Unit ◽  
Screening Tools ◽  
Pulse Oximetry Screening

AbstractPulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50–70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%.Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools. What is Known:• Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects.• Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee. What is New:• To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice.

Pulse oximetry screening for congenital heart defects in newborn infants: an evaluation of acceptability to mothers

2012 ◽  
Vol 98 (1) ◽  
pp. F59-F63 ◽  
Author(s):  
Rachael Powell ◽  
Helen M Pattison ◽  
Abhay Bhoyar ◽  
Alexandra T Furmston ◽  
Lee J Middleton ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Newborn Infants ◽  
Pulse Oximetry Screening

Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study

The Lancet ◽  
2011 ◽  
Vol 378 (9793) ◽  
pp. 785-794 ◽  
Author(s):  
Andrew K Ewer ◽  
Lee J Middleton ◽  
Alexandra T Furmston ◽  
Abhay Bhoyar ◽  
Jane P Daniels ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Newborn Infants ◽  
Test Accuracy ◽  
Accuracy Study ◽  
Pulse Oximetry Screening

Pulse Oximetry Screening for Congenital Heart Defects in Newborn Infants (Pulseox)

2012 ◽  
Vol 67 (1) ◽  
pp. 10-12 ◽  
Author(s):  
Andrew K. Ewer ◽  
Lee J. Middleton ◽  
Alexandra T. Furmston ◽  
Abhay Bhoyar ◽  
Jane P. Daniels ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Newborn Infants ◽  
Pulse Oximetry Screening

scholarly journals Screening for Critical Congenital Heart Defects with Pulse Oximetry: Medical Aspects

2016 ◽  
Vol 33 (11) ◽  
pp. 1062-1066 ◽  
Author(s):  
Andrew Ewer
Keyword(s):  
Clinical Practice ◽  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Published Data ◽  
Detection Rates ◽  
Early Onset Sepsis ◽  
Life Threatening ◽  
Pulse Oximetry Screening

The detection of newborn babies with potentially life-threatening, critical congenital heart defects (CCHDs) before they collapse or expire remains an important clinical challenge. The absence of physical signs and the difficulty assessing mild cyanosis means that the newborn baby check misses up to a third of babies. Fetal anomaly ultrasound scanning identifies an increasing proportion, but this screen is operator-dependent and therefore highly variable; although some units report very high detection rates, overall most babies with CCHD are still missed. Pulse oximetry screening (POS) is an additional test that meets the criteria for universal screening. POS increases overall detection of CCHD to over 90% and also identifies babies with noncardiac, hypoxemic conditions (such as congenital pneumonia, early-onset sepsis, and pulmonary hypertension), which are usually included in the false positives. There is a wealth of published data on the POS, both in a research setting and more recently in routine clinical practice, and consideration of POS is becoming increasingly widespread particularly among high-income countries. But a degree of controversy still remains, and debate continues regarding the most appropriate time to screen, the most effective screening pathway, and screening outside the well-baby nursery. So, should all newborn babies be screened with POS, if so, when and where should screening take place, what saturations are acceptable, and which conditions are we trying to identify? This review will look at the available evidence and try to suggest the way forward for those considering its introduction into their clinical practice.

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