Pulse Oximetry Screening for Detecting Congenital Heart Disease in Neonates – Experience from Tertiary Referral Children’s Hospital in South India

Background: Congenital heart disease is the most common type of birth defect in infancy with incidence of ۸ to ۱۲ per ۱۰۰۰ live births in India. Pulse oximetry has emerged as a good screening tool in the recent past in many countries being noninvasive and cost effective. This study aimed at estimating the accuracy of pulse oximetry as a standard screening method to detect congenital heart diseases (CHD) in neonates. Methods: This prospective observational study was conducted in a tertiary referral medical college hospital from December ۲۰۱۸ to June ۲۰۲۰. Pulse oximetry readings were taken of ۱۶۰۳ asymptomatic neonates breathing in room air from right hand and either foot after ۲۴ hours of birth. Pulse oximetry was considered positive if oxygen saturation in room air measured <۹۵% or difference between right hand and foot was more than ۳% persistently for ۳ readings as per the standard American Academy of Pediatrics algorithm. Neonates with positive pulse oximetry or those with persistent abnormal clinical examination underwent echocardiography. Results: Of the term neonates (n=۱۶۰۳) screened, incidence of CHD was ۰.۷ per ۱۰۰۰ live births and critical CHD was ۰.۳ per ۱۰۰۰ live births. The sensitivity, specificity, positive predictive value, and negative predictive value of pulse oximetry to detect any CHD were ۷۰.۶%, ۹۸.۸%, ۳۸.۷%, and ۹۹.۷%, major CHD was found to be ۶۰%, ۹۸.۴%, ۱۹.۴%, and ۹۹.۷%, and critical CHD to be ۸۵.۷%, ۹۸.۴%, ۱۹.۴%, and ۹۹.۹%, respectively. Pulse oximetry had significant positive correlation with abnormal clinical examination (R=۰.۲۹, p<۰.۰۰۱) and ECHO findings in detecting CHD (R=۰.۴۹, p<۰.۰۰۱). Regression model to evaluate whether abnormal clinical examination and positive pulse oximetry are significant predictors of CHD detected by ECHO was statistically significant (R۲ =۰.۳۴, p value <۰.۰۰۱) and both were significant independent predictors (p<۰.۰۰۱). Conclusion: Pulse oximetry screening is a useful tool for detecting congenital heart diseases in newborns.

Keywords:

congenital heart disease , , , , , pulse oximetry , , , , , screening , , , , , neonate