Pulse oximetry, a simple test for blood oxygen saturation, has the potential to detect congenital cardiac abnormalities in newborn babies that might be missed by antenatal ultrasonography and neonatal clinical examination. The PulseOx study is the largest test-accuracy investigation of pulse oximetry conducted in the UK to date. The findings of this study, which could improve postnatal care, are published in the Lancet. “Pulse oximetry offers added value to existing techniques and is likely to increase the number of critical lesions detected prior to [hospital] discharge, if it is introduced as a standard screening procedure”, explains Dr Andrew Ewer, from the University of Birmingham, UK, who was one of the study investigators.
This prospective investigation was conducted at six obstetric units between February 2008 and January 2009. During this period, 20,055 babies (>34 weeks gestation) were screened soon after birth (mean 12.4 h). Readings were taken from the infant's right hand (preductal saturation) and either foot (postductal saturation). Babies with a <95% oxygen saturation in either limb, or a 2% difference between limbs, were recorded as having hypoxemia. Echocardiography was performed if clinical examination indicated an abnormality or if oxygen saturation remained below the threshold on a second test. On the basis of echocardiography, cardiac abnormalities were classified as 'critical' (defects causing death or requiring intervention before 28 days of age), 'serious' (defects requiring intervention before 1 year of age), 'significant' (defects persisting longer than 6 months of age and requiring regular monitoring or drug treatment, but not classified as 'critical' or 'serious'), and 'nonsignificant' (defects not clinically appreciable and not persisting beyond 6 months of age). Notably, unlike earlier studies of pulse oximetry in newborns, babies who were identified as having heart defects on mid-gestation ultrasonography were included in the PulseOx study.
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