Role of Pulse Oximetry Screening for Detection of Life Threatening Congenital Heart Detects in Newborn

Most ofnewborns with Congenital Heart Defects (CHDs) can be detected by using echocardiography. However, if such defects are not diagnosed in earlier time, therefore a severe hypoxemia, shock, acidosis and death are considered of some potential sequelae. A prospective study from January 2012 to the end of 2013 was performed and 2181 neonates were enrolled in the study. The pulse oximetry screening (POS) for both hands and one foot were obtained within the first 3-6 hours of life, when post ductal saturation was below 90%, it was considered as a positive screening, while when the saturation is between 90-95% and the difference between pre-and post-ductal saturation was more than 3%, the baby was provisionally considered to be screening as a positive then echocardiography is planned. Among 100 positive POS babies, 45 (45%) of them were detected with CHS, 12 (12%) was with a major CHS and 33 (33%) was with a minor CHS. Out of 12 patients with a major CHD 6 of them (50%) were asymptomatic at the time of POS.POS result was a true negative in 2078 patients, a true positive in 45 patients, false negative in 3 patients, and false positive in 55 and 28/55 of the false positive rate with POS had other pathology. The false positive rate with pulse oximetry screening is (55/2081) = 0.26%. Sensitivity, specificity, positive and negative predictive value for POS in detection of major CHD were 80%, 97.29%, 17.9% and 99.80%, respectively. Pulse oximetry screening is significantly improving the detection of life threatening congenital heart disease at an early stage.

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Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

Cardiology in the Young ◽

10.1017/s1047951120002899 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1851-1855

Author(s):

Sruti Rao ◽

M. B. Goens ◽

Orrin B. Myers ◽

Emilie A. Sebesta

Keyword(s):

New Mexico ◽

Pulse Oximetry ◽

Sea Level ◽

False Positive ◽

False Positive Rate ◽

False Positives ◽

Moderate Altitude ◽

High False Positive Rate ◽

Positive Rate ◽

Pulse Oximetry Screening

AbstractAim:To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time.Methods:We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time.Results:Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = −0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88–0.97) per month.Conclusion:This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.

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

American Journal of Perinatology ◽

10.1055/s-0036-1586110 ◽

2016 ◽

Vol 33 (11) ◽

pp. 1062-1066 ◽

Cited By ~ 4

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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Faculty Opinions recommendation of Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717697909.793152973 ◽

2012 ◽

Author(s):

Willem Helbing

Keyword(s):

Systematic Review ◽

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Meta Analysis ◽

Pulse Oximetry Screening

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Pulse oximetry screening as a complementary strategy to detect critical congenital heart defects

Acta Paediatrica ◽

10.1111/j.1651-2227.2008.01199.x ◽

2009 ◽

Vol 98 (4) ◽

pp. 682-686 ◽

Cited By ~ 36

Author(s):

Alf Meberg ◽

Andreas Andreassen ◽

Leif Brunvand ◽

Trond Markestad ◽

Dag Moster ◽

...

Keyword(s):

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Complementary Strategy ◽

Pulse Oximetry Screening

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Selected birth defects data from population-based birth defects surveillance programs in the United States, 2005-2009: Featuring critical congenital heart defects targeted for pulse oximetry screening

Birth Defects Research Part A Clinical and Molecular Teratology ◽

10.1002/bdra.23098 ◽

2012 ◽

Vol 94 (12) ◽

pp. 970-983 ◽

Cited By ~ 27

Author(s):

Cara T. Mai ◽

Tiffany Riehle-Colarusso ◽

Alissa O'Halloran ◽

Janet D. Cragan ◽

Richard S. Olney ◽

...

Keyword(s):

United States ◽

Pulse Oximetry ◽

Birth Defects ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

The United States ◽

Population Based ◽

Surveillance Programs ◽

Pulse Oximetry Screening

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

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/fetalneonatal-2011-301225 ◽

2012 ◽

Vol 98 (1) ◽

pp. F59-F63 ◽

Cited By ~ 27

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

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Evaluation of optimal urine screening and confirmation cut-off values for opiates, at a national reference laboratory

Turkish Journal of Biochemistry ◽

10.1515/tjb-2020-0614 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Çiğdem Karakükcü ◽

Mehmet Zahid Çıracı ◽

Derya Kocer ◽

Mine Yüce Faydalı ◽

Muhittin Abdulkadir Serdar

Keyword(s):

False Positive ◽

False Positive Rate ◽

False Negative ◽

Urine Samples ◽

Reference Laboratory ◽

National Reference Laboratory ◽

Urine Screening ◽

National Reference ◽

Positive Rate ◽

Sensitivity Specificity

Abstract Objectives To obtain optimal immunoassay screening and LC-MS/MS confirmation cut-offs for opiate group tests to reduce false positive (FP) and false negative (FN) rates. Methods A total of 126 urine samples, −50 opiate screening negative, 76 positive according to the threshold of 300 ng/mL by CEDIA method – were confirmed by a full-validated in-house LC-MS/MS method. Sensitivity, specificity, FP, and FN rates were determined at cut-off concentrations of both 300 and 2,000 ng/mL for morphine and codeine, and 10 ng/mL for heroin metabolite 6-mono-acetyl-morphine (6-MAM). Results All CEDIA opiate negative urine samples were negative for morphine, codeine and 6-MAM. Although sensitivity was 100% for each cut-off; specificity was 54.9% at CEDIA cut-off 300 ng/mL vs. LC-MS/MS cut-off 300 ng/mL and, 75% at CEDIA cut-off 2,000 ng/mL vs. LC-MS/MS cut-off 2,000 ng/mL. False positive rate was highest (45.1%) at CEDIA cut-off 300 ng/mL. At CEDIA cut-off 2,000 ng/mL vs. LC-MS/MS cut-off 300 ng/mL, specificity increased to 82.4% and FP rate decreased to 17.6%. All 6-MAM positive samples had CEDIA concentration ≥2,000 ng/mL. Conclusions 2,000 ng/mL for screening and 300 ng/mL for confirmation cut-offs are the most efficient thresholds for the lowest rate of FP opiate results.

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Computed Tomography in Partial Carpal Arthrodesis

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80367-1 ◽

1997 ◽

Vol 22 (5) ◽

pp. 653-655

Author(s):

J. M. SOLER-MINOVES ◽

J. GONZALEZ-USTES ◽

R. PÉREZ ◽

M. GIFREU ◽

A. M. GALLART

Keyword(s):

Computed Tomography ◽

False Positive ◽

False Positive Rate ◽

False Negative ◽

Plain Radiography ◽

X Rays ◽

Positive Rate

We carried out X-rays and computed tomography in 59 wrists in patients who had previous surgical intercarpal fusions. 1.2 mm thick axial images were obtained perpendicular to the axis of the joint. CT showed whether or not the carpal fusions were united. Compared with CT, plain radiography yielded a 25% false negative and 6% false positive rate. We conclude that CT is more useful than plain X-rays for evaluating partial carpal arthrodesis.

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