Abstract
Background/aims: Critical congenital cardiovascular malformations (CCVMs) have been defined as lesions likely requiring surgical correction during the first month of life. CCVMs are relatively common, with a prevalence of 5–10 in every 1000 live births. Routine physical examination is unable to detect > 50% of CCVMs infants. Our aim was to verify the recent report by Koppel et al. (Pediatrics 2003;111:451–5), suggesting that a pulse oximetry screening, based on a single determination of postductal saturation (SpO2), is a noninvasive and highly specific test for early detection of CCVMs.
Methods: Oximetry was performed on 4197 asymptomatic newborns discharged from nursery at median age of 72 hours during the 2000 May 1-2004 March 31 period. Infants symptomatic before screening (heart murmur, severe cyanosis) and those with suspected lesions detected by fetal echocardiography were excluded. Cardiac ultrasound was performed on all infants with SpO2≤95% at > 24 hours (positive screens).
Results: Two cases of CCVMs were detected (intracardiac total anomalous pulmonary venous return with post-ductal SpO2 88% and ductal-dependent aortic coarctation with SpO2 85%). Both infants received surgical correction before the first month of life. There were no false-positive screens. One infant with negative screen was readmitted at 26 days of age for a non ductal-dependent aortic coarctation (false negative screen). The mean sensitivity value of the SpO2 was 66.7%, with 100% specificity, 100% positive predictive, and 100% negative predictive value. During the study period, the prevalence of critical CCVMs among the screened population was 1 in 1399.
Conclusion: Our findings confirm that neonatal pulse oximetry screening is a satisfactorily accurate, simple, noninvasive and inexpensive test for early detection of CCVMs which could be applied extensively especially to asymptomatic newborns in well-infant nurseries before discharge.
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Rosati, E., Chitano, G., Di Paola, L. et al. 228 Neonatal Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatr Res 56, 502 (2004). https://doi.org/10.1203/00006450-200409000-00251
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DOI: https://doi.org/10.1203/00006450-200409000-00251
