title: Screening for duct-dependant congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity.
abstract: OBJECTIVE
  To evaluate the feasibility of detecting duct-dependent congenital heart disease before hospital discharge by using pulse oximetry.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A supra-regional referral centre for paediatric cardiac surgery in Sweden.
  
  
  METHODS
  200 normal term newborns with echocardiographically normal hearts (median age 1.0 d) and 66 infants with critical congenital heart disease (CCHD; median age 3 d).
  
  
  METHODS
  Pulse oximetry was performed in the right hand and one foot using a new-generation pulse oximeter (NGoxi) and a conventional-technology oximeter (CToxi).
  
  
  RESULTS
  With the NGoxi, normal newborns showed a median postductal saturation of 99% (range 94-100%); intra-observer variability showed a mean difference of 0% (SD 1.3%), and inter-observer variability was 0% (SD 1.5%). The CToxi recorded a significantly greater proportion of postductal values below 95% (41% vs 1%) in the normal newborns compared with NGoxi (p<0.0001). The CCHD group showed a median postductal saturation of 90% (45-99%) with the NGoxi. Analysis of distributions suggested a screening cut-off of <95%; however, this still gave 7/66 false-negative patients, all with aortic arch obstruction. Best sensitivity was obtained by adding one further criterion: saturation of <95% in both hand and foot or a difference of >+/-3% between hand and foot. These combined criteria gave a sensitivity of 98.5%, specificity of 96.0%, positive predictive value of 89.0% and negative predictive value of 99.5%.
  
  
  CONCLUSIONS
  Systematic screening for CCHD with high accuracy requires a new-generation oximeter, and comparison of saturation values from the right hand and one foot substantially improves the detection of CCHD.
authors.affiliation: Department of Paediatric, Institute of Women's and Children's Health, The Sahlgren Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: de Wahl Granelli
authors.forename: Mats
authors.initials: M
authors.lastname: Mellander
authors.forename: Jan
authors.initials: J
authors.lastname: Sunnegårdh
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sandberg
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Ostman-Smith
mesh_terms: D016022:Case-Control Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods*; D015588:Observer Variation; D010092:Oximetry; D012372:ROC Curve; D012680:Sensitivity and Specificity