054-060
Role of pulse oximetry screening for detection of life threatening congenital heart defects in newborn
Authors: Dr. Riyadh Abd Aljabbar Sattar, Dr. Aso Faeq Salih and Prof. Dr. Adnan Mohammed Hamawandi
Number of views: 366
Prospective study included babies born at maternity hospital in sulaimany and babies born in private hospitals and referred to pediatric neonatal care unit in the first day of life for optimizing screening performance with pulse oximetry for detection of life threatening CHD. The study period was from 1 October 2012 to 1 march 2013. During that period 2371 live babies born. Out of these new born babies 2181 were enrolled in the study. The remaining newborns were excluded because they were premature, and the majority of them are hypoxic at birth due to immaturity of respiratory center which might lead to high false positive rate of POS. (Pulse oximetry screening). The POS for both hands and one foot were obtained within the first 3-6 hours of life. When post ductal saturation was below 90% it was considered as positive screening, while saturation between 90-95% and the difference between pre and post ductal saturation more than 3% the baby was provisionally considered to be screening positive, but a repeat measurement was performed. Babies with three repeated positive Measurements were arranged to have an echocardiogram performed in the same day according to the study protocol. The following information of each infant was recorded: Gestational age, age at echocardiography done, gender, birth weight, mode of delivery, Apgar score at 5 minutes, any association like IDM, IUGR, trisomy and any associated clinical presentation like murmur, cyanosis, tachypnea ,apnea and grunting. The main outcome in this study is measure of sensitivity, specificity, positive and negative predictive value of POS. Among 100 baby with positive POS, CHD was detected in 45 babies (45%) 12 babies were classified as major CHD and 33 babies as minor CHD. In 19 patient of all 45 patient there were additional clinical finding that might have prompted an echocardiographic evaluation: heart murmur (8), cyanosis (10), trisomy 21 (8). Of these 12 patients with major CHD 6 of them (50%) were asymptomatic at the time of POS. POS was true negative in 2078, true positive in 45 patients, false negative in 3 patients, and false positive in 55 and 28/55 of the false positive rate with POS had other pathology. And false positive rate with pulse oximetry screening is (55/2081) = 2, 6%. Sensitivity, specificity, positive and negative predictive value for POS in detection of major CHD were 80%, 97.29%, 17.9% and 99.80%, respectively. Our study showed that pulse oximetry screening of all well babies in maternity units is practically feasible with a minimum use of time, and that it significantly improves detection of life threatening congenital heart disease at an early stage. A significant number of newborns with critical congenital heart defects that have not been detected prenatally can be identified at an asymptomatic stage, before clinical deterioration occurs. This makes it possible to avoid cardiogenic shock in these patients before hospital discharge.
Keywords: Pulse oximetry, Echocardiography, Screening, Congenetal, Heart defect
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