Comparison of pulse oximetry screening versus routine clinical examination in detecting critical congenital heart disease in newborns

Abstract

Critical congenital heart disease (CCHD) in newborns has a worldwide prevalence of 1-2 per 1000 live births and often remain asymptomatic pre-discharge, leading to significant morbidity and mortality. Screening depends on physical examination (PE) and pulse oximetry (PO) which is proposed as a novel method. Objective: Evaluate efficacy and suitability of PO as a screening strategy of CCHD compared to PE in the Sri Lankan setup. Method: A prospective study was conducted in 5435 asymptomatic newborns, period of amenorrhoea (POA) ≥34weeks, aged ≥24 hours, in Castle Street Hospital for Women, Colombo. Preductal and post-ductal oxygen saturation (SpO2) measurements in right hand (RH) and right foot (RF) along with PE were performed. Babies without SpO2 thresholds of ≥95% in RH and RF and ≤3% difference between RH and RF or with abnormal PE, underwent 2D echocardiogram. Results: Detection rate of CCHD by PO and PE were 91% and 82% respectively. Addition of PO screening to PE detected 02 missed cases. PO and PE sensitivities were 90.9% and 81.8% (p=0.54) and 100% in combination (p=0.8), and specificities were 99.9% and 98.2% respectively (p=0.37) and 98.1% in combination. Positive predictive value