DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181504

Can pulse oxymetry be used as a routine screening tool in early diagnosis of critical congenital heart diseases in newborns?

Gomathi Chenna Reddy, K. N. Devaraj

Abstract


Background: Unrecognition or delayed diagnosis of severe congenital cardiac diseases (CCD) can lead to cardiac failure, cardiovascular collapse and death. Pulse oximetry can be used as a screening tool for detection of critical CCD (CCCD) in newborns. We conducted this study to correlate pulse oximetry findings in asymptomatic newborns to detect CCCD and coarctation of aorta.

Methods: All babies delivered in our hospital were included; after clinical evaluation, pulse oximetry screening was done 12 hours after delivery, taken in three extremities (Right thumb, left thumb and left great toe). If the readings were <95% in any of the limbs, they were further evaluated to detect cardiac defects.

Results: Of 800 babies, 54.4% were males and 66.1% were delivered by normal vaginal delivery. Antenatal scan of all were normal. Mean±SD birth weight was 2.92 kg ±.29 ranging 2.14 Kgs-3.80 kgs. Oxygen saturation was >95% in 799 babies, there was no significant clinical findings, and were negative for pulse oxymetry screening; one baby had positive pulse oximetry screening (<95%) with ‘ejection systolic murmur’ over left 2nd and 3rd intercostal space. There was no evidence of cyanosis, oedema or tachypnoea. Pulse oximetry reading was 88% in right thumb, 90% in left thumb and 92% in left great great toe. Echocardiography showed Atrial Septal Defect, Ventricular Septal Defect with Pulmonary Stenosis.

Conclusions: Pulse oximetry is a non-invasive, reliable, and useful screening tool for an early detection of CCCD in newborns. The combination of pulse oximetry and clinical judgement is needed.


Keywords


Critical congenital heart disease, Early detection, Echocardiography newborns, Pulse oxymetry

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References


Bernstein D. Congenital heart disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Editors. Nelson text book of pediatrics. 18th edition. Philadelphia: Saunders; 2007:1878-81.

Saxena A, Mehta A, Sharma M, Salhan S, Kalaivani M, Ramakrishnan S et al., Birth prevalence of congenital heart disease: A cross-sectional observational study from North India. Ann Pediatr Card. 2016;9:205-9.

Aamir T, Kruse L, Ezeakudo O. Delayed diagnosis of critical congenital cardiovascular malformations (CCVM) and pulse oximetry screening of newborns. Acta Paediatr. 2007;96:1146-9.

Katzman GH. The newborn’s SpO2: a routine vital sign whose time has come? Pediatri 1995;95:161-2.

William T. Mahle, G Paul Matherne, Samuel Gidding. Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease. Amer Heart Assoc Amer Acad Pediatri. 2009;120:447-58.

Reich JD, Miller S, Brogdon B, Casatelli J, Gompf TC, Huhta JC, et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr. 2003;142: 268-72.

Gupta H, Anand S, Grover N, Negi PC. Role of Pulse Oximetry for the Early Detection of Congenital Heart Diseases: A Prospective Observational Study. Int J Med Res Prof. 2017;3:227-31.

Lone MR, Malik RA, Ganie NA, Ahmed A, Buch NA, Ali SW. Role of pulse oximetry in screening of critical congenital heart disease in asymptomatic neonates. Int J Contemp Pediatr. 2016;3:563-7.

Palve N, Utture A, Nanavati R, HireA, Kerkar P. Pulse oximetry screening for critical congenital heart disease - Experience in a public hospital in India. Indian J Child Health. 2017;4:216-20.

Saxena A, Mehta A, Ramakrishnan S, Sharma M, Salhan S, Kalaivani M et al. Pulse oximetry as a screening tool for detecting major congenital heart defects in Indian newborns. Archi Dis Child- Fetal and Neonatal Edi. 2015;100:F416-21.

Taksande A, Lakhkar B, Gadekar A, Suwarnakar K, Japzape T. Accuracy of pulse oximetry screening for detecting critical congenital heart disease in the newborns in rural hospital of Central India. Images Paediatr Cardiol. 2013;15:5-10.

Jones AJ, Howarth C, Nicholl R, Mat-Ali E, Knowles R. The impact and efficacy of routine pulse oximetry screening for CHD in a local hospital. Cardiol Young. 2016;26:1397-405.

Gupta SK, Saxena A. Pulse Oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Ind Heart J 2012;64:110.

Lightfoot M, Hough P, Hudak A, Gordon M, Barker S, Meeder R, et al. Audit of pulse oximetry screening for critical congenital heart disease (CCHD) in newborns. Paediatr Child Health 2017;22:305-6.

Wong KK, Fournier A, Fruitman DS, Graves L, Human DG, Narvey M, et al. Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease. Can J Cardiol 2017;33:199-208.

Swenson AK, Brown D, Stevermer JJ. Pulse oximetry for newborns: Should it be routine? Hickner J, ed. The Journal of Family Practice 2012;61:283-6.

Kumar RK. Screening for congenital heart disease in India: Rationale, practical challenges, and pragmatic strategies. Ann Pediatr Cardiol 2016;9:111-4.

Tsao PC, Shiau YS, Chiang SH, Ho HC, Liu YL, Chung YF, et al. Development of a Newborn Screening Program for Critical Congenital Heart Disease (CCHD) in Taipei. Chuang J-H, ed. PLoS ONE 2016;11:e0153407.

Oster ME, Aucott SW, Glidewell J, Hackell J, Kochilas L, Martin GR, et al. Lessons learned from newborn screening for critical congenital heart defects. Pediatr. 2016;137:e20154573.

Chamsi-Pasha MA, Chamsi-Pasha H. Critical congenital heart disease screening. Avicenna J Med. 2016;6:65-8.

John C, Phillips J, Hamilton C, Lastliger A. Implementing Universal Pulse Oximetry Screening in West Virginia: Findings from Year One. W V Med J 2016;112:42-6.

Hu XJ, Zhao QM, Ma XJ, Yan WL, Ge XL, Jia B, et al. Pulse oximetry could significantly enhance the early detection of critical congenital heart disease in neonatal intensive care units. Acta Paediatr. 2016;105:e499-505.

Mouledoux J, Guerra S, Ballweg J, Li Y, Walsh W. A novel, more efficient, staged approach for critical congenital heart disease screening. J Perinatol. 2017;37:288-90.

Bernstein D. Congenital heart disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Editors. Nelson text book of pediatrics. 18th ed. Philadelphia. Saunders; 2007:1878-81.

Chang RK, Rodriguez S, Klitzner TS. Screening newborns for congenital heart disease with pulse oximetry: survey of pediatric cardiologists. Pediatr Cardiol. 2009;30:20-5.

Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: A systematic review and meta-analysis. Lancet. 2012;379:2459-64.

Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, et al., Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): A test accuracy study. Lancet. 2011;378:785-94.

Salyer JW. Neonatal and pediatric pulse oximetry. Respir Care. 2003;48:386-96.

Gidding SS, Anisman P. What pediatric residents should learn (or what pediatricians should know) about congenital heart disease. Pediatr Cardiol. 2003;24:418-23.

Toth B, Becker A, Seelbach-Göbel B. Oxygen saturation in healthy newborn infants immediately after birth measured by pulse oximetry. Arch Gynecol Obstet. 2002;266:105-7.

Koppel RI, Druschel CM, Carter T, Goldberg BE, Mehta PN, Talwar R, et al., Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatri. 2003;111:451-5.

Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol. 2005;26:832-5.

Rosati E, Chitano G, Dipaola L, De Felice C, Latini G. Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease. J Perinat Med. 2005;33:455-7.

Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation. 2001;103:1269–73

Arlettaz R, Bauschatz AS, Mönkhoff M, Essers B, Bauersfeld U. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr. 2006;165:94-8.

Ruangritnamchai C, Bunjapamai W, Pongpanich B. Pulse oximetry screening for clinically unrecognized critical congenital heart disease in the newborns. Images Paediatr Cardiol. 2007;9(1):10-5.

Dulal, Bipul Kumar, Anuradha, Matada V. Pulse oximetry screening of newborns for detection of congenital heart disease in a neonatal intensive care unit from a tertiary care hospital of North East India. J Evidence Medic Healthcare. 2016;3:1185-8.

Mathur NB, Gupta A, Kurien S. Pulse Oximetry Screening to Detect Cyanotic Congenital Heart Disease in Sick Neonates in a Neonatal Intensive Care Unit. Indian Pediatr. 2015;52:769-72.

Shenoy KD, Rao SS. Positive predictive value of pulse oximetry in the screening of critical congenital heart defects in term neonates. Int J Contemp Pediatr. 2017;4:832-6.

Hamilçıkan Ş, Can E. Critical congenital heart disease screening with a pulse oximetry in neonates. J Perinat Med. 2018;46:203-7.