Evaluation of pulse oximetry screening in Middle Tennessee: cases for consideration before universal screening

Area of Science:

• Neonatal Medicine
• Public Health Screening
• Cardiology

Background:

• Pulse oximetry screening is proposed for detecting critical congenital heart disease (CHD) in asymptomatic newborns.
• This study evaluates the effectiveness and challenges of this screening in a real-world, non-research setting.

Purpose of the Study:

• To assess the performance of pulse oximetry screening for critical CHD in a public health program.
• To identify practical issues and limitations encountered during screening implementation.

Main Methods:

• Evaluation of an elective, state-directed pulse oximetry screening program for 14,564 infants in Middle Tennessee.
• Screening conducted by nurses in local hospitals after 24 hours of age and before discharge.
• Analysis of screening results, including positive predictive value and false positive rates.

Main Results:

• The positive predictive value for critical CHD was less than 1% (1 true positive, 112 false positives).
• The single true positive case was not referred for evaluation.
• Antenatal diagnosis combined with physical examination identified 43 of 44 critical CHD cases.

Conclusions:

• Current pulse oximetry screening protocols in this setting yielded a high rate of false positives.
• Significant challenges exist regarding educational and referral systems for screening.
• A defined system of care is necessary before considering universal implementation of newborn screening for critical CHD.