Evaluation of pulse oximetry screening in Middle Tennessee: cases for consideration before universal screening.
OBJECTIVE
Pulse oximetry screening of asymptomatic newborns is suggested as a life-saving procedure for the timely detection of critical congenital heart disease (CHD) in asymptomatic newborns. We evaluated this screening and report cases that demonstrate problems with screening in a non-research setting.


METHODS
An elective state-directed public health screening program was evaluated in Middle Tennessee; 14 564 infants were screened after 24 h of age and before discharge. The screening was performed in a non-research setting by nurses at the local hospitals. A parallel investigation of the methods and timing of diagnosis in Middle Tennessee revealed a surprisingly high incidence of antenatal diagnosis (66%).


RESULTS
Using a saturation value of 94% as the defined normal, the positive predictive value was less than 1%, with 112 infants having a false positive case and 1 having a true positive case identified (incidence 1/34 775). The one true positive case was not referred for evaluation. One false-positive case resulted in a costly referral and hospitalization. Antenatal diagnosis when combined with physical examination detected 43 of 44 infants with critical CHD during the year-long evaluation.


CONCLUSIONS
Before universal screening can be implemented, a system of care must be defined to address the educational and referral issues raised by this report.
Walsh
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Division of Neonatology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN 37232-9550, USA. bill.walsh@vanderbilt.edu
D058070:Asymptomatic Diseases; D003152:Community Health Nursing; D016638:Critical Illness; D042241:Early Diagnosis; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D020380:Needs Assessment / Q000458:organization & administration; D017283:Neonatal Nursing; D015997:Neonatal Screening / Q000191:economics / Q000592:standards; D010092:Oximetry / Q000191:economics / Q000706:statistics & numerical data; D010808:Physical Examination / Q000379:methods / Q000451:nursing; D015397:Program Evaluation; D058028:Research Report; D013714:Tennessee