Can Pulse Oximetry Screening Reduce the Postnatal Diagnostic Gap in Critical Congenital Heart Diseases?
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- Category: Vol. 80, March 2012
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Can Pulse Oximetry Screening Reduce the Postnatal Diagnostic Gap in Critical Congenital Heart Diseases?,MOHAMED A. EL-SAYED, HATEM EL-SHORBAGY, BASEM S. ALDEEK and SAFIAA BASONDWA
Abstract
Objective: To evaluate the use of pulse oximetry (POS) to screen for early detection of life threatening congenital heart disease.
Design: We conducted a prospective study in Jeddah in King Abdulaziz University Hospital and Alazizia Hospital. From October 2009 to January 2011 where POS was performed preductally (palm of right hand) and postductally (either foot) in 920 apparently healthy term infants before discharge. The infants’ age at screening, sex, and delivery mode (caesarean section or vaginal) and the technical quality of the measurement (optimal or not optimal) were recorded on a reporting form. When both preductal and postductal oxygen saturation was <95% or the difference between the two s was >3% (>!2 standard deviations of inter-observer measurement) the baby was provisionally considered to be screening positive and three recordings were analysed separately then confirmed after 1h. Complete clinical examination and echocardiography were performed.
Main Outcome Measures: Sensitivity, specificity, positive and negative predictive values, and likelihood ratio for pulse oximetry screening and for neonatal physical examination alone.
Results: 19 babies had duct dependent circulation. In 16 cases, pulse oximetry showed oxygen saturations !990% (true positive). The remaining 3 cases, were detected by physical examination alone. Combining physical examination with pulse oximetry screening detected 100% of the babies with duct dependent lung circulation. False positive rate with pulse oximetry was substantially lower than that with physical examination alone (48/920) (5.21%) v 119/920 (12.93%), p<0.0001), and 8/48 of the “false positive” cases with pulse oximetry had other pathology.
POS was true positive in 16 cases, false positive in 48 cases, true negative in 853 and false negative in 3 cases.
Sensitivity, specificity, positive and negative predictive value were 77.78%, 99.90%, 25.93% and 99.99%, respectively.
Conclusion: Introducing pulse oximetry screening before discharge as an adjunct to prenatal diagnosis, physical exam-ination and clinical observation improved total detection rate of duct dependent circulation to 92%. Such screening seems cost effective on the long term and should be implemented in routine postnatal care.