Role of pulse oximetry in screening of critical congenital heart disease in asymptomatic neonates

Mohd Rafiq Lone, Riyaz Ahmad Malik, Nisar Ahmad Ganie, Asif Ahmed, Niyaz Ahmad Buch, Syed Wajid Ali


Background: Neonatal screening for critical congenital heart disease can aid in early recognition and improved outcome of critical congenital heart diseases. Our aim was to assess the performance of pulse oximetry as a screening tool for the detection of critical congenital heart diseases in asymptomatic neonates.

Methods: Our study was a hospital based prospective study conducted on all asymptomatic neonates brought to neonatology section of tertiary care hospital. Pulse oximetric screening was performed by a single determination of postductal oxygen saturation in all asymptomatic newborns that fulfilled the inclusion criteria. To ensure universal screening, the timing of pulse oximetric determination was >24 hrs age. All newborns found to have a post-ductal saturation ≤95% underwent additional evaluation by echocardiography. Data regarding true and false positives as well as negatives was collected and sensitivity, specificity and predictive values of pulse oximetry for screening of asymptomatic newborns with congenital heart disease were determined.

Results: 2600 neonates were screened and 7 cases of CCHD were diagnosed, giving a prevalence of 0.27 %. Sensitivity, specificity, positive predictive value and negative predictive value of pulse oximetry for detection of CCHD were 77.78%, 99.92%, 77.78% and 99.92%, respectively.

Conclusions: We conclude that pulse oximetry is safe, easily available and reasonably accurate for screening of CCHD with sensitivity better than antenatal screening and clinical examination. Its specificity and negative predictive value are very high, making second stage confirmatory echocardiography highly cost-effective. Thus, the results of this study add to the already growing body of evidence that strongly supports introduction of pre discharge pulse oximetry screening as a routine procedure in healthy newborn babies.


Pulse oximetry, Congenital heart disease, Screening

Full Text:



Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States; trends and racial disparities, 1979-1997, circulation. 2001;103:2376-81.

Mississippi Regular Session House Bill. 2005.

Bonnet D, Coltri A, Butera G, Fermont L, Le Bidios J, Kachaner J, et al. Detection of transposition of the great arteries in fetuses Reduces neonatal morbidity and mortality,. Circulation. 1999;99:916-8.

Soongswang J, Adatia I, Newman C, Smallhorn JF, Williams WG, Freedom RM. Mortality in potential arterial switch candidates with transportation of the great arteries. J Am Coll Cardiol. 1998;32:753-7.

Chang RK. How many infants with critical congenital heart diseases are missed? Circulation. 2007;116(2):2-614.

Less MH. Cyanosis of the newborn infant: recognition and clinical evaluation. J Pediatr. 1970;77:484-98.

Vaidyanathan B, Sathish G. A prospective study in a community hospital in Kerala. Indian pediatrics. 2011;48:25-30.

Payne RM, Johnson MC, Grant JW, Strauss AW. Toward a molecular understanding of congenital heart disease. Circulation. 1995;91:494-504.

Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart diseases worsens preoperative condition and outcome of surgery in neonates. Heart. 2006;92:1298-302.

Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart. 2002;87:67-9.

Tworetsky 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.

Bull C. for the British pediatric cardiac association. Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK. Lancet. 1999;354:1242-47.

Wren C, Richmond S, Donaldson L. Presentation of congenital Heart disease in infancy: implications for routine examination. Arch dis Child Fetal neonatal ED. 1999;80:F49-F53.

Cartlidge PH. Routine discharge examination of babies, is it necessary? Arch Dis Child. 1992;67:1421-2.

Tegnander E, Willias W, Johansen OJ, Blass H-GK, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30149n fetuses- detection rates and outcomes. Ultrasound obstet Gynecol. 2006;27:252-65.

Garne E, Stoll C, Clementi M, and the euroscan group. Evaluation of prenatal diagnosis of congenital heart disease by ultrasound: experience from 20 European registries. Ultrasound Obstet gynecol. 2001;17:386-91.

Hoke TR, Donohue PK, Bawa PK, Mitchell Rd, Pathak A, Rowe PC, et al. Oxygen saturation as a screening test for critical congenital heart disease a preliminary study. Pediatr Cardiol. 2002;23:403-9.

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.

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

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

Meberg A, Brugmann-Pieper S, Due R, Eskedal I, Fagerli I, Farstad T, et al. First day of life pulse oximetry screening to detect congenital heart diseases (published correction appears in J pediatr 2009; 154-629) J Pediatr. 2008;152:761-5.

Sendelbach DM, Lai S, Jackon GJ, Fixler D, Stechl Ek, Engle WD. Pulse oximetry (Pox) Screening of term and late pre-term neonates at 4 hours postnatal (PN) to detect cyanotic congenital heart disease (CCHD). Presented at Pediatrics Academic Societies; Honolulu Hawaii. 2008;2-6.

Tautz J, Merkel C, Loersch F. Implication of pulse oximetry screening for detection of congenital heart defects. Klin Padiatr. 2010;222(5):291-5.

Richmond S, Reay G, Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed. 2002;87: F83-F88.

Riede FT, Dähnert I, Schneider P, Möckel A. Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects. Pediatrics. 2009;123:e542.

Mahle WT, Newburger JW, Matherene GP, Smith FC, Hoke TR, Koppel R, et al. Role of pulse oximetry in examining newborns for congenital heart disease; a scientific statement from AHA and AAP. Pediatrics. 1997;124:823-36.

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. Pediatrics. 2003;111:451-5.

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.