Screening of Newborn by Pulse Oximetry at Birth for the Critical Congenital Heart Disease
Background: Early diagnosis of congenital heart disease is important for a good clinical outcome. Unrecognized or delayed diagnosis of some severe congenital heart diseases can lead to cardiac failure, cardiovascular collapse, and even death. Pulse oximetry screening (POS) in newborns has been shown to enhance the detection of critical congenital heart disease (CCHD). Clinical evaluation is likely to miss the diagnosis in first few hours of hospital stay after birth due to absence of signs and symptoms of CCHD. In the absence of clinical findings during early neonatal period, the best parameter that can be assessed, is the detection of hypoxemia by pulse oximetry screening. Aims and Objectives: Usefulness of pulse oximetry in newborn for early detection of Critical Congenital Heart Disease (CCHD). Material and Methods: This Prospective Observational Study was conducted on 125 newborn babies in postnatal ward at tertiary care centre for a period of 2 years satisfying the inclusion and exclusion criteria. Evaluation was done between 24 to 48 hours of birth with pulse oximeter. Institutional ethics committee permission was taken prior to study. Results and Conclusion: Total 125 neonates were screened by pulse oximeter, 2 were detected to have positive screen for Congenital Heart Disease (CHD) of which 1 had CCHD confirmed by echocardiography. Study revealed that Pulse Oximetry screening can be an important screening tool in routine neonatal care for early detection of CCHD.
- Zhao QM, Ma XJ, Ge XL, Liu F, Yan WL, Wu L, Ye M, Liang XC, Zhang J, Gao Y, Jia B. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. The Lancet. 2014; 384(9945):747–54. https://doi.org/10.1016/S01406736(14)60198-7 DOI: https://doi.org/10.1016/S0140-6736(14)60198-7
- Hoffman JI, Kaplan S. The incidence of congenital heart disease. Journal of the American College of Cardiology. 2002; 39(12):1890–900. https://doi.org/10.1016/S07351097(02)01886-7 DOI: https://doi.org/10.1016/S0735-1097(02)01886-7
- Reich JD, Connolly B, Bradley G, Littman S, Koeppel W, Lewycky P, et al. Reliability of a single pulse oximetry reading as a screening test for congenital heart disease in otherwise asymptomatic newborn infants: The importance of human factors. Pediatric Cardiology. 2008; 29(2):371–6. https://doi.org/10.1007/s00246-007-9105-z. PMid:17932712 DOI: https://doi.org/10.1007/s00246-007-9105-z
- Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. temporal trends in survival among infants with critical congenital heart defects. 2013. https://doi.org/10.1542/peds.2012-3435. PMid:23610203. DOI: https://doi.org/10.1542/peds.2012-3435
- Rosano A, Botto LD, Botting B, Mastroiacovo P. Infant mortality and congenital anomalies from 1950 to 1994: An international perspective. Journal of Epidemiology and Community Health. 2000; 54(9):660–6. https://doi.org/10.1136/jech.54.9.660. PMid:10942444. PMCid: PMC1731756
- Kuehl KS, Loffredo CA, Ferencz C. Failure to diagnose congenital heart disease in infancy. Pediatrics. 1999; 103(4):743–7. https://doi.org/10.1542/peds.103.4.743. PMid: 10103296 DOI: https://doi.org/10.1542/peds.103.4.743
- Wren C, Richmond S, Donaldson L. Presentation of congenital heart disease in infancy: implications for routine examination. Archives of Disease in Childhood Fetal and Neonatal Edition. 1999; 80(1):F49–53. https://doi.org/10.1136/fn.80.1.F49. PMid:10325813. PMCid: PMC1720871 DOI: https://doi.org/10.1136/fn.80.1.F49
- Ainsworth SB, Wyllie JP, Wren C. Prevalence and clinical significance of cardiac murmurs in neonates. Archives of Disease in Childhood-Fetal and Neonatal Edition. 1999; 80(1):F43–5. https://doi.org/10.1136/fn.80.1.F43. PMid:10325811. PMCid:PMC1720873 DOI: https://doi.org/10.1136/fn.80.1.F43
- Reich JD, Miller S, Brogdon B, Casatelli J, Gompf TC, Huhta JC, Sullivan K. The use of pulse oximetry to detect congenital heart disease. The Journal of Pediatrics. 2003; 142(3):268–72. https://doi.org/10.1067/mpd.2003.87. PMid: 12640374 DOI: https://doi.org/10.1067/mpd.2003.87
- Botto LD, Correa A, Erickson JD. Racial and temporal variations in the prevalence of heart defects. Pediatrics. 2001; 107:E32. https://doi.org/10.1542/peds.107.3.e32. PMid:11230613 DOI: https://doi.org/10.1542/peds.107.3.e32
- Talner CN. Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler, MD, Pediatrics, 1980;65(suppl):375-461. Pediatrics. 1998; 102(1 Pt 2):258–9. https://doi.org/10.1542/peds.102.S1.258. PMid:9651450 DOI: https://doi.org/10.1542/peds.102.S1.258
- Heron MP, Smith BL. Deaths: leading causes for 2003. National Vital Statistics System. 2007; 55:1–92.
- Rosano A, Botto LD, Botting B, Mastroiacovo P. Infant mortality and congenital anomalies from 1950 to 1994: An international perspective. Journal of Epidemiology and Community Health. 2000; 54:660–66. https://doi.org/10.1136/jech.54.9.660. PMid:10942444. PMCid: PMC1731756 DOI: https://doi.org/10.1136/jech.54.9.660
- Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States: Trends and racial disparities, 1979 –1997. Circulation. 2001; 103:2376–81. https://doi.org/10.1161/01.CIR.103.19.2376. PMid:11352887 DOI: https://doi.org/10.1161/01.CIR.103.19.2376
- Mississippi 2005 Regular Session, House Bill 1052; 2005.
- Wong KK, Fournier A, Fruitman DS, Graves L, Human DG, Narvey M, et al. Canadian Cardiovascular Society/ Canadian Pediatric Cardiology Association position statement on pulse oximetry screening in newborns to enhance detection of critical congenital heart disease. Canadian Journal of Cardiology. 2017; 33:199–208. https://doi.org/10.1016/j.cjca.2016.10.006. PMid:28043739 DOI: https://doi.org/10.1016/j.cjca.2016.10.006
- Kumar RK. Screening for congenital heart disease in India: Rationale, practical challenges, and pragmatic strategies. Annals of Pediatric Cardiology. 2016; 9:111–4. https://doi.org/10.4103/0974-2069.181499. PMid:27212843. PMCid: PMC4867793 DOI: https://doi.org/10.4103/0974-2069.181499
- Hu XJ, Zhao QM, Ma XJ, Yan WL, Ge XL, Jia B, et al. Pulse oximetry could significantly enhance the early detection of critical congenital heart disease in neonatal intensive care units. Acta Paediatrica. 2016; 105:e499–505. https://doi.org/10.1111/apa.13553. PMid:27540721. PMCid: PMC5095792 DOI: https://doi.org/10.1111/apa.13553
- Mouledoux J, Guerra S, Ballweg J, Li Y, Walsh W. A novel, more efficient, staged approach for critical congenital heart disease screening. Journal of Perinatology. 2017; 37:288–90. https://doi.org/10.1038/jp.2016.204. PMid:27831548. PMCid: PMC5334208 DOI: https://doi.org/10.1038/jp.2016.204
- Arlettaz R, Bauschatz AS, Mönkhoff M, Essers B, Bauersfeld U. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. European Journal of Pediatrics. 2006; 165(2):94–8. https://doi.org/10.1007/s00431-005-0006-y. PMid:16211399 DOI: https://doi.org/10.1007/s00431-005-0006-y
- Ruangritnamchai C, Bunjapamai W, Pongpanich B. Pulse oximetry screening for clinically unrecognized critical congenital heart disease in the newborns. Images in Paediatric Cardiology. 2007; 9(1):10–5.
- Mathur NB, Gupta A, Kurien S. Pulse oximetry screening to detect cyanotic congenital heart disease in sick neonates in a neonatal intensive care unit. Indian Pediatrics. 2015; 52:769–72. https://doi.org/10.1007/s13312-015-0714-y. PMid:26519711 DOI: https://doi.org/10.1007/s13312-015-0714-y
- Shenoy KD, Rao SS. Positive predictive value of pulse oximetry in the screening of critical congenital heart defects in term neonates. International Journal of Contemporary Pediatrics. 2017; 4:832–6. https://doi.org/10.18203/23493291.ijcp20171523 DOI: https://doi.org/10.18203/2349-3291.ijcp20171523
- Bernstein D. Congenital heart disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Editors. Nelson text book of pediatrics. 18th ed. Philadelphia. Saunders; 2007. p. 1878–81.
- Chang RK, Rodriguez S, Klitzner TS. Screening newborns for congenital heart disease with pulse oximetry: survey of pediatric cardiologists. Pediatric Cardiology. 2009; 30:20–5. https://doi.org/10.1007/s00246-008-9270-8. PMid:18654813 DOI: https://doi.org/10.1007/s00246-008-9270-8
- Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. The Lancet. 2012; 379(9835):2459–64. https://doi.org/10.1016/S0140-6736(12)60107-X DOI: https://doi.org/10.1016/S0140-6736(12)60107-X
- Ewer AK, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): A test accuracy study. Lancet. 2011; 378(9793):785–94. https://doi.org/10.1016/S0140-6736(11)60753-8 DOI: https://doi.org/10.1016/S0140-6736(11)60753-8
- Jones AJ, Howarth C, Nicholl R, Mat-Ali E, Knowles R. The impact and eicacy of routine pulse oximetry screening for CHD in a local hospital. Cardiology in the Young. 2016; 26(7):1397–405. https://doi.org/10.1017/S1047951115002784.PMid:26905447 DOI: https://doi.org/10.1017/S1047951115002784