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Early screening for critical congenital heart defects in asymptomatic newborns in Bursa province
Elif Özalkaya1, Arzu Akdağ2, Ismail Şen2
1a Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children Training and Research Hospital , Istanbul , Turkey and.
Insights
Pulse oximetry screening can miss critical congenital heart disease (CCHD), particularly coarctation of the aorta. Repeating screening may improve early diagnosis of CCHD in newborns.
Area of Science:
- Neonatal screening
- Cardiology
- Public Health
Background:
- Critical congenital heart diseases (CCHD) require early detection for improved outcomes.
- Pulse oximetry is a common screening tool for CCHD in newborns.
Purpose of the Study:
- To evaluate the effectiveness of pulse oximetry screening for the early diagnosis of CCHD.
- To assess the diagnostic accuracy of pulse oximetry for CCHD, with a focus on coarctation of the aorta.
Main Methods:
- A cohort of 10,200 newborns was screened using pulse oximetry.
- Screening criteria included oxygen saturation ≤ 95% or a ≥ 3% difference between upper and lower extremities after 24 hours of birth.
Main Results:
- The incidence of CCHD was 1 in 1000 live births, with coarctation of the aorta being the most frequent.
- Pulse oximetry demonstrated 60% sensitivity and 99.8% specificity for CCHD.
- A 40% false-negative rate was observed, with 75% of these false negatives being coarctation of the aorta.
Conclusions:
- Pulse oximetry screening within the first 24-48 hours may miss diagnoses of coarctation of the aorta.
- Repeated pulse oximetry screening is recommended for the early detection of coarctation of the aorta.
Objective:
In this study, pulse oximetry screening results in the early diagnosis of critical congenital heart diseases (CCHD) will be evaluated.
Methods:
Eight-thousand two-hundred and eight of 10,200 newborns born between January 2014 and December 2014 were screened using pulse oximetry for the diagnosis of CCHD. Screening test was considered to be positive in the newborns whose saturation after 24 h from the birth with pulse oximetry was ≤ 95% and/or in the newborns who had a difference of ≥ 3% between the lower and right upper extremity.
Results:
Incidence of CCHD was 1 per 1000 live births. Coarctation of the aorta was the most commonly determined CCHD. Sensitivity, specificity, false negative rate and false positive rate of pulse oximetry in the diagnosis of CCHD were 60%, 99.8%, 40% and 0.12%, respectively. Seventy-five percent of the newborns who had a false negative diagnosis with pulse oximetry had coarctation of the aorta. Coarctation of the aorta was determined at a rate of 20% using CCHD screening.
Conclusions:
The diagnosis of coarctation of the aorta is missed in the newborns screened with pulse oximetry in the first 24-48 h after birth. Screening with pulse oximetry should be repeated for early diagnosis of coarctation of the aorta.
