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Pulse oximetry as a screening tool for detecting major congenital heart defects in Indian newborns
Anita Saxena1, Anurag Mehta1, Sivasubramanian Ramakrishnan1
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Pulse oximetry effectively screens for major congenital heart defects (CHDs) in Indian newborns, significantly improving detection rates when combined with clinical examination. While sensitive, its specificity for identifying CHDs requires further investigation.
Area of Science:
- Neonatal Medicine
- Cardiology
- Public Health
Background:
- Congenital heart defects (CHDs) are a significant cause of neonatal morbidity and mortality worldwide.
- Early detection of CHDs is crucial for timely intervention and improved outcomes.
- Current screening methods in India primarily rely on clinical examination, which has limitations.
Purpose of the Study:
- To evaluate the effectiveness of pulse oximetry as a screening tool for major congenital heart defects (CHDs) in Indian newborns.
- To compare the diagnostic accuracy of pulse oximetry, clinical examination, and their combination for detecting CHDs.
Main Methods:
- A cross-sectional observational study was conducted in a North Indian community hospital over three years.
- 19,009 newborns were screened using routine clinical examination, pulse oximetry, and bedside echocardiography.
- Sensitivity and specificity of each screening method for major CHDs were calculated.
Main Results:
- Pulse oximetry alone detected 55.7% of major CHDs and 84.6% of critical CHDs.
- Combining pulse oximetry with clinical examination significantly improved sensitivity for major CHDs to 75.7% (p<0.01) and critical CHDs to 84.6% (p<0.01).
- The specificity of pulse oximetry for major CHDs was 68.3%.
Conclusions:
- Pulse oximetry is a sensitive screening tool for major CHDs in Indian newborns.
- It enhances the detection capabilities beyond clinical examination alone.
- Lower specificity in this cohort may be attributed to factors like infection prevalence and oximeter type.
Objective:
To evaluate the use of pulse oximetry as a screening tool for detecting major congenital heart defects (CHDs) in Indian newborns.
Design:
Cross-sectional observational study.
Patients:
In a community hospital of north India, babies born during a specific 8 h period of the day were recruited over a period of 3 years. Newborns with incomplete documentation were excluded.
Intervention:
Routine clinical examination, pulse oximetry and bedside echocardiography.
Outcome Measures:
Any abnormalities in clinical examination and pulse oximetry were recorded. CHDs were diagnosed using bedside echocardiography. Accuracy of pulse oximetry, clinical examination and their combination for detecting major CHDs was calculated.
Results:
Among the 19 009 newborns screened, 70 had major CHDs at birth (44 serious, 26 critical). Pulse oximetry detected 39 major (sensitivity 55.7%, 95% CI 44.1% to 66.8%; specificity 68.3%, 67.6% to 68.9%) and 22 critical CHDs (sensitivity 84.6%, 66.5% to 93.9%; specificity 68.3%, 67.6% to 68.9%). Addition of pulse oximetry to clinical examination significantly improved sensitivity for major CHDs (35.7% (25.5% to 47.4%) to 75.7% (64.5% to 85.3%), p<0.01) and critical CHDs (11.5% (4.0% to 29.0%) to 84.6% (66.5% to 93.9%), p<0.01).
Conclusions:
Pulse oximetry is a sensitive screening tool for detecting major CHDs in Indian newborns. It adds significant value to the current practice of using clinical examination as a sole screening tool for detecting major CHDs. However, specificity of pulse oximetry was much lower in our study. Possible reasons for low specificity could be non-repetition of pulse oximetry in newborns with initial lower saturations, high prevalence of infections and respiratory issues in our cohort and use of non-motion tolerant oximeter.
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