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Newborn Pulse Oximetry Screening for Detecting Congenital Heart Disease: Experience at a Tertiary Care Center
Ziad R Bulbul1, Nour K Younis2, Farah Malaeb1
1Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
Pulse oximetry screening (POS) effectively detects critical congenital heart disease (CCHD) in newborns but is suboptimal for simple CHDs. POS remains a cost-effective screening tool for CCHD when prenatal screening is insufficient.
Area of Science:
- Pediatrics
- Neonatology
- Cardiology
Background:
- Congenital heart disease (CHD) is the most common birth defect globally.
- Pulse oximetry screening (POS) is a standard method for detecting critical CHD (CCHD).
- Tertiary care centers evaluate POS accuracy and cost-effectiveness in well-babies.
Purpose of the Study:
- Assess the accuracy and cost-effectiveness of POS for CHD detection.
- Evaluate POS in term infants admitted to a regular nursery.
- Compare POS findings with echocardiography and fetal screening data.
Main Methods:
- Retrospective chart review of term infants in a newborn nursery over one year.
- Collected POS results and echocardiography findings.
- Analyzed data from a fetal echocardiography program for screened fetuses.
Main Results:
- No term infants had positive POS results at birth or 24 hours.
- 10 of 56 infants with echocardiograms before discharge had simple CHD.
- 6 of 53 infants with echocardiograms within five years had simple CHD.
- 21 fetuses were diagnosed with CHD, including 5 critical cases.
Conclusions:
- POS is cost-effective for CCHD screening, especially without robust prenatal programs.
- POS is not sensitive enough for detecting simple, noncritical CHDs.
- Echocardiography remains crucial for diagnosing simple CHD.
Background:
Congenital heart disease (CHD) remains the number one birth defect worldwide. Pulse oximetry screening (POS) is a widely used CHD screening modality effective in detecting critical lesions. This study is aimed at assessing the accuracy and cost-effectiveness of POS in a cohort of term well-babies admitted to a regular nursery in a tertiary care center.
Methods:
We reviewed the charts of term babies admitted to our regular nursery over a period of one year. The results of POS and the findings of echocardiography were collected. Similarly, we explored the records of our fetal echocardiography program to identify the fetuses screened for CHD during the same period.
Results:
900 term babies were born and admitted to newborn nursery at our center, and 69 fetuses were evaluated by our fetal cardiology team during the study period. None of our term babies had a positive POS at birth or 24 hours of age. However, 56 babies had a cardiac echo before hospital discharge due to suspicious findings on physical examination or a family history of CHD. A simple noncritical CHD was noted in 10 of them. Additionally, 53 babies underwent echocardiography within the first five years of life; a simple CHD was noted in 6 of them. In parallel, 21 of our fetuses were found to have CHD: 16 simple CHD and 5 critical CHD (CCHD).
Conclusion:
Despite its cost-effectiveness and efficacy in screening for CCHD, POS is suboptimal for detecting simple CHD. In the absence of a proper prenatal screening and fetal echocardiography program, POS remains a cost-effective modality for detecting CCHD.
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