title: Pulse oximetry as a screening tool for detecting major congenital heart defects in Indian newborns.
abstract: OBJECTIVE
  To evaluate the use of pulse oximetry as a screening tool for detecting major congenital heart defects (CHDs) in Indian newborns.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  In a community hospital of north India, babies born during a specific 8 h period of the day were recruited over a period of 3 years. Newborns with incomplete documentation were excluded.
  
  
  METHODS
  Routine clinical examination, pulse oximetry and bedside echocardiography.
  
  
  METHODS
  Any abnormalities in clinical examination and pulse oximetry were recorded. CHDs were diagnosed using bedside echocardiography. Accuracy of pulse oximetry, clinical examination and their combination for detecting major CHDs was calculated.
  
  
  RESULTS
  Among the 19 009 newborns screened, 70 had major CHDs at birth (44 serious, 26 critical). Pulse oximetry detected 39 major (sensitivity 55.7%, 95% CI 44.1% to 66.8%; specificity 68.3%, 67.6% to 68.9%) and 22 critical CHDs (sensitivity 84.6%, 66.5% to 93.9%; specificity 68.3%, 67.6% to 68.9%). Addition of pulse oximetry to clinical examination significantly improved sensitivity for major CHDs (35.7% (25.5% to 47.4%) to 75.7% (64.5% to 85.3%), p<0.01) and critical CHDs (11.5% (4.0% to 29.0%) to 84.6% (66.5% to 93.9%), p<0.01).
  
  
  CONCLUSIONS
  Pulse oximetry is a sensitive screening tool for detecting major CHDs in Indian newborns. It adds significant value to the current practice of using clinical examination as a sole screening tool for detecting major CHDs. However, specificity of pulse oximetry was much lower in our study. Possible reasons for low specificity could be non-repetition of pulse oximetry in newborns with initial lower saturations, high prevalence of infections and respiratory issues in our cohort and use of non-motion tolerant oximeter.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sivasubramanian
authors.initials: S
authors.lastname: Ramakrishnan
authors.affiliation: Department of Pediatrics, Columbia Asia Hospital, Gurgaon, Haryana, India.
authors.forename: Mamta
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Obstetrics and Gynaecology, Hindu Rao Hospital, New Delhi, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Salhan
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M
authors.initials: M
authors.lastname: Kalaivani
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
mesh_terms: D003430:Cross-Sectional Studies; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods*; D010092:Oximetry; D015995:Prevalence; D012680:Sensitivity and Specificity
keywords: Cardiology; Congenital Abnorm; Neonatology; Screening