title: Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis.
abstract: BACKGROUND
  Screening for critical congenital heart defects in newborn babies can aid in early recognition, with the prospect of improved outcome. We assessed the performance of pulse oximetry as a screening method for the detection of critical congenital heart defects in asymptomatic newborn babies.
  
  
  METHODS
  In this systematic review, we searched Medline (1951-2011), Embase (1974-2011), Cochrane Library (2011), and Scisearch (1974-2011) for relevant citations with no language restriction. We selected studies that assessed the accuracy of pulse oximetry for the detection of critical congenital heart defects in asymptomatic newborn babies. Two reviewers selected studies that met the predefined criteria for population, tests, and outcomes. We calculated sensitivity, specificity, and corresponding 95% CIs for individual studies. A hierarchical receiver operating characteristic curve was fitted to generate summary estimates of sensitivity and specificity with a random effects model.
  
  
  RESULTS
  We screened 552 studies and identified 13 eligible studies with data for 229,421 newborn babies. The overall sensitivity of pulse oximetry for detection of critical congenital heart defects was 76·5% (95% CI 67·7-83·5). The specificity was 99·9% (99·7-99·9), with a false-positive rate of 0·14% (0·06-0·33). The false-positive rate for detection of critical congenital heart defects was particularly low when newborn pulse oximetry was done after 24 h from birth than when it was done before 24 h (0·05% [0·02-0·12] vs 0·50 [0·29-0·86]; p=0·0017).
  
  
  CONCLUSIONS
  Pulse oximetry is highly specific for detection of critical congenital heart defects with moderate sensitivity, that meets criteria for universal screening.
  
  
  BACKGROUND
  None.
authors.affiliation: Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Electronic address: s.thangaratinam@qmul.ac.uk.
authors.forename: Shakila
authors.initials: S
authors.lastname: Thangaratinam
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK.
authors.forename: Kiritrea
authors.initials: K
authors.lastname: Brown
authors.affiliation: Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
authors.affiliation: Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Ewer
mesh_terms: D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening; D010092:Oximetry