Accuracy of pulse oximetry versus arterial blood gas in screening cyanotic heart

Smita Ramachandran, Akriti Gera, Rani Gera, Saurabh Kataria, Manas Pratim Roy


Background: A study was planned To determine the performance and accuracy of pulse oximetry in children with cyanotic heart diseases compared with arterial oxygen saturation measurements from arterial blood gas analysis and to use transcutaneous pulse oximeter as the first line of non-invasive investigation to diagnose cyanotic heart diseases in peripheral and rural health facilities where echocardiography may not be readily available.

Methods: This was a prospective observational study conducted in Safdarjung Hospital. Children with cyanotic congenital heart disease were enrolled the data was analyzed by using PASW Statistics version 19.0 (SPSS Inc., Chicago, IL, US). Frequency and percentage was calculated for categorical variables. Mean and standard deviation was calculated for continuous variables. Chi‑square test and Fisher’s exact test was used to compare categorical variables. Correlation was assessed between ABG and SpO2.

Results: A total number of 40 children were enrolled. There was a significant correlation between transcutaneous oxygen saturations and arterial oxygen saturation statistically.

Conclusions: The pulse oximeter detected oxygen saturation comparable to arterial oxygen saturation in all the patients with cyanotic heart diseases, even though most of them did not present with clinically significant cyanosis.


Transcutaneous pulse oximeter, Arterial blood oxygen saturation, Cyanotic heart disease, Children

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Bolisetty S, Daftary A, Ewald D, Knight B, Wheaton G. Congenital heart defects in Central Australia. Med J Aust. 2004;180:614-7.

Vlamari P. Should pulse oximetry be used to screen for congenital heart disease?. Arch Dis Child Fetal Neonatal Ed. 2007;92(3):F219-24.

Kuehl KS, Loffredo CA, Ferencz C. Failure to diagnose congenital heart disease in infancy. Pediatrics. 1999;103(4 Pt 1):743-7.

Ross PA, Newth CJL. Accuracy of Pulse Oximetry in Children. Pediatrics. 2014;133:22-9.

Van der Linde D, Konings EE, Slager MA. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58:2241-7.

Kapoor R, Gupta S. Prevalence of congenital heart disease, Kanpur, India. Indian Pediatr. 2008;45(4):309-11.

Patra S, Rama Sastry UM, Mahimaiha J, Subramanian AP, Shankarappa RK, Nanjappa MC. Spectrum of cyanotic congenital heart disease diagnosed by echocardiographic evaluation in patients attending paediatric cardiology clinic of a tertiary cardiac care centre. Cardiol Young. 2015;25(5):861-7.

Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, et al. Role of pulse oximetry in examining newborns for congenital heart disease. A scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation. 2009;120:447-8.

Evans N. Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health. 2000;36:169-71.

Katumba-Lunyenya JL. Neonatal/infant echocardiography by the non-cardiologist: a personal practice, past, present, and future. Arch Dis Child Fetal Neonatal Ed. 2002;86:F55-7.

Schmitt HJ, Schuetz WH, Proeschel PA, Jaklin C. Accuracy of pulse oximetry in children with cyanotic congenital heart disease. J Cardiothorac Vasc Anesth. 1993;7:61-5.

Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol. 2005;26(6):832-5.

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(3):268-72.

Saxena A, Mehta A, Ramakrishnan S, Sharma M. Pulse oximetry as a screening tool for detecting major congenital heart defects in Indian newborns. Arch Dis Child Fetal Neonatal Ed. 2015;100:F416-21.

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

Kemper AR, Mahle WT, Martin GR. Strategies for implementing screening for critical congenital heart disease. Pediatrics. 2011;128:e1259-67.

Vaidyanathan B, Sathish G, Mohanan ST, Sundaram KR. Clinical Screening for Congenital Heart Disease at Birth: A Prospective Study in a Community Hospital in Kerala. Indian Pediatrics. 2011;48:25-30.

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.

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.