Pulse oximetry screening performed during the first hours of life improves the detection of potentially life-threatening congenital heart defects and other severe diseases in apparently healthy newborns, and should be incorporated into routine neonatal care, according to a study conducted in Norway.
"Pulse oximetry screening improves the detection rate of critical congenital heart defects compared to clinical screening only, and picks up congenital heart defects very early," lead author Dr. Alf Meberg told Reuters Health. "Early detection of extracardiac disorders may be an additional advantage of the screening program, possibly as important as detecting heart defects."
Dr. Meberg, a neonatologist at Vestfold Hospital in Tonsberg, and colleagues conducted a prospective study of postductal arterial oxygen saturation (SpO 2) in 50,008 newborns at 14 Norwegian hospitals.
The oximeter probe was placed on the foot for at least 2 minutes until a stable value was obtained. If the SpO 2was <>
"The median age when a low SpO 2 initiated further investigations was 6 hours (range, 1 - 21 hours)," the investigators report in the Journal of Pediatrics for June.
After the first test, 324 (0.6%) infants were classified as pathological, either because of symptoms (32) or persistent low oxygen saturation when re-tested (292).
Ultimately, 43 of these infants (13%) were found to have congenital heart defects, including 27 that were deemed critical.
These included multiple cases of transposition of the great arteries, atrioventricular or ventricular septal defect, total anomalous pulmonary venous return, coarctation of the aorta, pulmonary atresia, and aortic stenosis. Physicians also identified one case each of pulmonary stenosis, common arterial truncus, tetralogy of Fallot, and single ventricle.
Pulse oximetry also identified 134 extracardiac disorders, including transient tachypnea, pneumonia/septicemia, pulmonary hypertension, pneumothorax, amniotic fluid aspiration, and hypoglycemia. Single cases of pulmonary atelectasis, polycythemia, infantile pulmonary fibromatosis, respiratory distress syndrome, and cardiomyopathy were also diagnosed.
The other 147 infants who had persistent SpO 2 levels <>
The investigators estimate that pulse oximetry screening had a sensitivity of 77.1% and specificity of 99.4% in detecting critical congenital heart defects.
"This modality is intriguing and promising," Dr. William T. Mahle, a cardiologist at Children's Healthcare of Atlanta and author of an accompanying editorial, noted in correspondence with Reuters Health. "Still, larger studies are needed, studies in rural US hospitals would be helpful, and studies at higher altitude would also be valuable."
In his editorial, Dr. Mahle suggests a potential alternative strategy of oximetry screening after 24 hours but before hospital discharge as a way to reduce costs associated with false-positive results.
Dr. Meberg disagrees: "Time matters, and the advantage of early diagnosis of critical congenital heart defects as well as extracardiac disorders, favors early screening before postponing it." He and his colleagues recommend screening "a couple of hours after birth."
He does agree that "studies to understand the value of pulse oximetry in universal screening for cardiopulmonary disorders should be carried out."
He and his colleagues "are now looking into how the diagnosis of critical congenital heart defects was undertaken in the hospitals (in Norway) not taking part in the study," he said. "Time for diagnosis, and especially how many were missed in the hospitals not performing pulse oximetry screening, compared to those which screened, are important data for further evaluation of the pulse oximetry screening program."
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