Pediatric Cardiology

, Volume 26, Issue 6, pp 832–835 | Cite as

Combining Pulse Oximetry and Clinical Examination in Screening for Congenital Heart Disease

Article

Abstract

The objective of this study was to evaluate combined pulse oximetry and clinical examination as a screening method for congenital heart disease (CHD) in asymptomatic newborns. Asymptomatic newborns were screened for CHD using pulse oximetry and clinical examination before their discharge from the nursery. Oxygen saturation ≥94% was considered normal. Echocardiography was done for newborns with abnormal readings and for those with significant murmurs. Data concerning undetected cases were collected from the pediatric referral hospital. A total of 5211 cases were screened. Echocardiographic evaluations were done based on low pulse oximetry in five cases and on murmur detection in ten others. The sensitivity of the combined method of screening was 77%, whereas it was 31% for oximetry alone and 46% for clinical examination alone. Specificity was ∼100% for all methods. The positive predictive value of the combined tool was 66.7%. We conclude that combining pulse oximetry and clinical examination can enhance the clinician’s ability to detect life-threatening CHD in a timely manner. This screening method should become a part of the discharge plan for every newborn.

Keywords

Congenital heart disease Pulse oximetry Clinical examination Neonatal screening Asymptomatic newborns 

References

  1. 1.
    Ainsworth, SB, Wyllie, JP, Wren, C 1999Prevalence and clinical significance of cardiac murmurs in neonatesArch Dis Child Fetal Neonatal Ed80F4345PubMedGoogle Scholar
  2. 2.
    Byard, RW, Moore, L 1991Total anomalous pulmonary venous drainage and sudden death in infancyForens Sci Intl51197202Google Scholar
  3. 3.
    Elsas, LJ 1996

    Newborn screening

    Rudolph, AM eds. Rudolph’s pediatricsAppleton & LangeStamford (CT)282288
    Google Scholar
  4. 4.
    Grech, V 2000Diagnostic and interventional trends in tetralogy of Fallot and transposition of the great arteries in a population-based studyPediatr Cardiol21368373PubMedGoogle Scholar
  5. 5.
    Hall, DMB eds. 1996Health for all children. Report of the Third Joint Working Party on Child Health SurveillanceOxford University PressOxfordGoogle Scholar
  6. 6.
    Hiatt, PW, Mahony, L, Tepper, RS 1992Oxygen desaturation during sleep in infants and young children with congenital heart diseaseJ Pediatr121226232PubMedGoogle Scholar
  7. 7.
    Koppel, RI, Druschel, CM, Carter, T,  et al. 2003Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newbornsJ Pediatr142268272Google Scholar
  8. 8.
    Kuehl, KS, Loffredo, CA, Ferencz, C 1999Failure to diagnose congenital heart disease in infancyPediatrics103743747CrossRefPubMedGoogle Scholar
  9. 9.
    Payne, RM, Johnson, MC, Grant, JW, Strauss, AW 1995Toward a molecular understanding of congenital heart diseaseCirculation91494504PubMedGoogle Scholar
  10. 10.
    Reddy, VK, Holzman, IR, Wedgwood, JF 1999Pulse oximetry saturations in the first 6 hours of life in normal term infantsClin Pediatr388792Google Scholar
  11. 11.
    Reich, JD, Miller, S, Brogdon, B,  et al. 2003The use of pulse oximetry to detect congenital heart diseasePediatrics111451455Google Scholar
  12. 12.
    Richmond, S, Reay, G, Abu Harb, M 2002Routine pulse oximetry in the asymptomatic newbornArch Dis Child87F83F88Google Scholar
  13. 13.
    Saxena, A 2003Issues in newborn screeningGenet Test7131134CrossRefPubMedGoogle Scholar
  14. 14.
    Silove, ED 1994Assessment and management of congenital heart in the newborn by the district paediatricianArch Dis Child70F71F74Google Scholar
  15. 15.
    Usen, S, Weber, M, Mulholland, K 1999Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort studyBMJ3188691PubMedGoogle Scholar
  16. 16.
    Varan, B, Tokel, K, Yilmaz, G 1999Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertensionArch Dis Child814952PubMedGoogle Scholar
  17. 17.
    Wren, C, Richmond, S, Donaldson, L 1999Presentation of congenital heart disease in infancy: implications for routine examinationArch Dis Child Fetal Neonatal Ed80F49F53PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of AlexandriaAlexandriaEgypt
  2. 2.Neonatal Intensive Care UnitKing Abdel-Aziz Specialist HospitalTaifSaudi Arabia
  3. 3.Department of PediatricsKing Abdulaziz University–JeddahJeddahSaudi Arabia

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