Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns.
OBJECTIVE
To determine the sensitivity, specificity, predictive value, and accuracy of a program of pulse oximetry screening of asymptomatic newborns for critical congenital cardiovascular malformation (CCVM).


METHODS
Pulse oximetry was performed on asymptomatic newborns in the well-infant nurseries of 2 hospitals. Cardiac ultrasound was performed on infants with positive screens (saturation <or=95% at >24 hours). Data regarding true and false positives as well as negatives were collected and analyzed.


RESULTS
Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases of CCVM were detected (total anomalous pulmonary venous return x2, truncus arteriosus). During the study interval, there were 9 live births of infants with CCVM from a group of 15 fetuses with CCVM detected by fetal echocardiography. Six infants with CCVM were symptomatic before screening. There was 1 false-positive screen. Two infants with negative screens were readmitted (coarctation, hypoplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were nonurgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of critical CCVM among all live births was 1 in 564 and among the screened population was 1 in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive value: 75%; negative predictive value: 99.98%; accuracy: 99.97%).


CONCLUSIONS
This screening test is simple, noninvasive, and inexpensive and can be administered in conjunction with state-mandated screening. The false-negative screen patients had lesions not amenable to detection by oximetry. The sensitivity, specificity, and predictive value in this population are satisfactory, indicating that screening should be applied to larger populations, particularly where lower rates of fetal detection result in increased CCVM prevalence in asymptomatic newborns.
Koppel
Robert I
RI
Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, NY 11040, USA. rkoppel@lij.edu
Druschel
Charlotte M
CM
Carter
Tonia
T
Goldberg
Barry E
BE
Mehta
Prabhu N
PN
Talwar
Rohit
R
Bierman
Fredrick Z
FZ
D005069:Evaluation Studies as Topic; D005315:Fetal Diseases / Q000175:diagnosis / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000592:standards*; D009518:New York / Q000453:epidemiology; D010092:Oximetry / Q000592:standards*; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal