European Journal of Pediatrics

, Volume 165, Issue 2, pp 94–98 | Cite as

The contribution of pulse oximetry to the early detection of congenital heart disease in newborns

  • Romaine ArlettazEmail author
  • Andrea Seraina Bauschatz
  • Marion Mönkhoff
  • Bettina Essers
  • Urs Bauersfeld
Original Paper


Approximately half of all newborns with congenital heart disease are asymptomatic in the first few days of life. Early detection of ductal-dependant cardiac malformations prior to ductal closure is, however, of significant clinical importance, as the treatment outcome is related to the time of diagnosis. Pulse oximetry has been proposed for early detection of congenital heart disease. The aims of the present study were: 1) to determine the effectiveness of a pulse-oximetric screening performed on the first day of life for the detection of congenital heart disease in otherwise healthy newborns and 2) to determine if a pulse-oximetric screening combined with clinical examination is superior in the diagnosis of congenital heart disease to clinical examination alone. This is a prospective, multi-centre study. Postductal pulse oximetry was performed between six and twelve hours of age in all newborns of greater than 35 weeks gestation. If pulse-oximetry-measured arterial oxygen saturation was less than 95%, echocardiography was performed. Pulse oximetry was performed in 3,262 newborns. Twenty-four infants (0.7%) had repeated saturations of less than 95%. Of these infants, 17 had congenital heart disease and five of the remaining seven had persistent pulmonary hypertension. No infant with a ductal-dependant or cyanotic congenital heart disease exhibited saturation values greater or equal to 95%. Conclusion: postductal pulse-oximetric screening in the first few days of life is an effective means for detecting cyanotic congenital heart disease in otherwise healthy newborns.


Congenital heart disease Newborns Pulse oximetry 



congenital heart disease


ductus arteriosus


negative predictive value


positive predictive value


pulse oximetry



We thank Dr. Zeljika Beric who helped perform the echocardiograms, the nursing staff who performed the POx measurements and Derek Brown for his editorial assistance.


  1. 1.
    Abu-Harb M, Hey E, Wren C (1994) Death in infancy from unrecognised congenital heart disease. Arch Dis Child 71:3–7PubMedGoogle Scholar
  2. 2.
    Abu-Harb M, Wyllie J, Hey E, Richmond S, Wren C (1994) Presentation of obstructive left heart malformations in infancy. Arch Dis Child Fetal Neonatal Ed 71:F179–F183PubMedGoogle Scholar
  3. 3.
    Ainsworth SB, Wyllie JP, Wren C (1999) Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed 80:F43–F45PubMedGoogle Scholar
  4. 4.
    Archer N (1999) Cardiovascular disease. In: Rennie J, Roberton N (eds) Textbook of neonatology, 3rd edn. Churchill Livingstone, Edinburgh, pp 673–713Google Scholar
  5. 5.
    Arlettaz R, Archer N, Wilkinson AR (1998) Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child Fetal Neonatal Ed 78:F166–F170PubMedGoogle Scholar
  6. 6.
    Bauersfeld U, Ghisla R, Günthard J (2002) Kinderkardiologie. Paediatrica 13:51–54Google Scholar
  7. 7.
    Braudo M, Rowe RD (1961) Auscultation of the heart—early neonatal period. Am J Dis Child 101:67–78Google Scholar
  8. 8.
    Bull C; British Paediatric Cardiac Association (1999) Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK. Lancet 354:1242–1247CrossRefGoogle Scholar
  9. 9.
    Danford DA (1995) Cost-effectiveness of echocardiography for evaluation of children with murmurs. Echocardiography 12:153–162PubMedCrossRefGoogle Scholar
  10. 10.
    Danford DA (2002) Sorting through the haystack—decision analysis and the search for heart disease among children with murmur. J Pediatr 141:465–467CrossRefPubMedGoogle Scholar
  11. 11.
    Du ZD, Roguin N, Barak M (1997) Clinical and echocardiographic evaluation of neonates with heart murmurs. Acta Paediatr 86:752–756PubMedCrossRefGoogle Scholar
  12. 12.
    Farrer KFM, Rennie JM (2003) Neonatal murmurs: are senior house officers good enough? Arch Dis Child Fetal Neonatal Ed 88:F147–F151CrossRefPubMedGoogle Scholar
  13. 13.
    Fasnacht M, Pfammatter JP, Ghisla R, Sekarski N, Steinmann H, Kuen P, Guenthard J (2005) FETCH study: prospective fetal cardiology study in Switzerland. Cardiol Young 15(Suppl 2):35AGoogle Scholar
  14. 14.
    Frommelt MA (2004) Differential diagnosis and approach to a heart murmur in term infants. Pediatr Clin N Am 51:1023–1032CrossRefGoogle Scholar
  15. 15.
    Gerstmann D, Berg R, Haskell R, Brower C, Wood K, Yoder B, Greenway L, Lassen G, Ogden R, Stoddard R, Minton S (2003) Operational evaluation of pulse oximetry in NICU patients with arterial access. J Perinatol 23:378–383CrossRefPubMedGoogle Scholar
  16. 16.
    Gidding SS (1992) Pulse oximetry in cyanotic congenital heart disease. Am J Cardiol 70:391–392CrossRefPubMedGoogle Scholar
  17. 17.
    Gregory J, Emslie A, Wyllie J, Wren C (1999) Examination for cardiac malformations at six weeks of age. Arch Dis Child Fetal Neonatal Ed 80:F46–F48PubMedCrossRefGoogle Scholar
  18. 18.
    Hoke TR, Donohue PK, Bawa PK, Mitchell RD, Pathak A, Rowe PC, Byrne BJ (2002) Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study. Pediatr Cardiol 23:403–409CrossRefPubMedGoogle Scholar
  19. 19.
    Knowles R, Griebsch I, Brown J, Bull C, Wren C, Dezateux C (2004) Comparing screening strategies to identify congenital heart defects in newborn babies. Arch Dis Child 89(A1):P17CrossRefGoogle Scholar
  20. 20.
    Koppel RI, Druschel CM, Carter T, Goldberg BE, Mehta PN, Talwar R, Bierman FZ (2003) Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatr 111:451–455CrossRefGoogle Scholar
  21. 21.
    Levesque BM, Pollack P, Griffin BE, Nielsen HC (2000) Pulse oximetry: what’s normal in the newborn nursery? Pediatr Pulmonol 30:406–412CrossRefPubMedGoogle Scholar
  22. 22.
    McCrindle BW (2004) The prevalence of congenital cardiac lesions. In: Freedom RM, Yoo SJ, Mikailian H, Williams WG (eds) The natural and modified history of congenital heart disease. Blackwell Publishing, Oxford, UK, ISBN 1-4051-0360-4, pp 8–15Google Scholar
  23. 23.
    Mitchell SC, Korones SB, Berendes HW (1971) Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 43:323–332PubMedGoogle Scholar
  24. 24.
    O’Brien LM, Stebbens VA, Poets CF, Heycock EG, Southall DP (2000) Oxygen saturation during the first 24 hours of life. Arch Dis Child Fetal Neonatal Ed 83:F35–F38CrossRefPubMedGoogle Scholar
  25. 25.
    Reich JD, Miller S, Brogdon B, Casatelli J, Gompf TC, Huhta JC, Sullivan K (2003) The use of pulse oximetry to detect congenital heart disease. J Pediatr 142:268–272CrossRefPubMedGoogle Scholar
  26. 26.
    Richmond S, Reay G, Abu-Harb M (2002) Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fet Neonatal Ed 87:F83–F88CrossRefGoogle Scholar
  27. 27.
    Richmond S, Wren C (2001) Early diagnosis of congenital heart disease. Semin Neonatol 6:27−35CrossRefPubMedGoogle Scholar
  28. 28.
    Schmitt HJ, Schuetz WH, Proeschel PA, Jaklin C (1993) Accuracy of pulse oximetry in children with cyanotic congenital heart disease. J Cardiothorac Vasc Anesth 7:61–65CrossRefPubMedGoogle Scholar
  29. 29.
    Silove ED (1994) Assessment and management of congenital heart disease in the newborn by the district paediatrician. Arch Dis Child Fetal Neonatal Ed 70:F71–F74PubMedGoogle Scholar
  30. 30.
    Wren C, Richmond S, Donaldson L (1999) Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed 80:F49–F53PubMedCrossRefGoogle Scholar
  31. 31.
    Yi MS, Kimball TR, Tsevat J, Mrus JM, Kotagal UR (2002) Evaluation of heart murmurs in children: cost-effectiveness and practical implications. J Pediatr 141:504–511CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Romaine Arlettaz
    • 1
    Email author
  • Andrea Seraina Bauschatz
    • 1
  • Marion Mönkhoff
    • 2
  • Bettina Essers
    • 3
  • Urs Bauersfeld
    • 4
  1. 1.Clinic of NeonatologyUniversity HospitalZurichSwitzerland
  2. 2.Neonatal UnitHospital ZollikerbergZurichSwitzerland
  3. 3.Neonatal UnitHospital TriemliZurichSwitzerland
  4. 4.Division of Paediatric CardiologyUniversity Children’s HospitalZurichSwitzerland

Personalised recommendations