title: Clinical examination and pulse oximetry as screening for congenital heart disease in low-risk newborn.
abstract: OBJECTIVE
  To assess sensitivity, specificity, positive predictive value and negative predictive value of the cardiovascular physical examination (CPE) and of pulse oximetry in screening for congenital heart diseases (CHD) in asymptomatic newborn when prenatal ultrasound evaluation is negative for structural cardiac abnormalities.
  
  
  METHODS
  In this observational cohort study, 5750 asymptomatic newborns, admitted to nursery in a period of 2 years, underwent to CPE and determination of arterial oxygen saturation by pulse oxymetry between 48th and 72nd h of life.
  
  
  RESULTS
  Two hundred and ninty-eight newborns presented a suspected CPE; in 70% of cases, we found a transitional alteration and in only 17% of cases, the echocardiography examination performed for suspected CPE were completely negative. Three newborns were positive to pulse oximetry screening test but negative at CPE. After discharge, one case of critical CHD was diagnosed.
  
  
  CONCLUSIONS
  An accurate CPE performed by trained and experienced pediatricians is indicative of important cardiac structural alteration in more than 25%. The association of CPE and pulse oximetry allows to further improve the diagnostic accuracy.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Zuppa
authors.forename: Riccardo
authors.initials: R
authors.lastname: Riccardi
authors.forename: Piero
authors.initials: P
authors.lastname: Catenazzi
authors.forename: Vito
authors.initials: V
authors.lastname: D'Andrea
authors.forename: Maria
authors.initials: M
authors.lastname: Cavani
authors.forename: Annamaria
authors.initials: A
authors.lastname: D'Antuono
authors.forename: Alma
authors.initials: A
authors.lastname: Iafisco
authors.forename: Costantino
authors.initials: C
authors.lastname: Romagnoli
mesh_terms: D015331:Cohort Studies; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening; D010092:Oximetry; D012384:Rome / Q000453:epidemiology
keywords: Congenital heart diseases; early diagnosis; neonatal heart; neonatal outcome; pulse oximetry screening