Article

Review of pulse oximetry screening for critical congenital heart defects in newborn infants

University of Birmingham and Birmingham Women's Hospital, Birmingham, UK.
Current opinion in cardiology (Impact Factor: 2.59). 01/2013; 28(2):92-6. DOI: 10.1097/HCO.0b013e32835d7e42
Source: PubMed

ABSTRACT The concept of using pulse oximetry as a screening method to detect undiagnosed critical congenital heart defects (CCHD) in asymptomatic newborns was first explored over 10 years ago. A number of studies were subsequently reported, which initially involved relatively small numbers of patients, low prevalence of CCHD and heterogeneous methodology. As a consequence, the majority of clinicians felt the case for routine pulse oximetry screening had not been proven.
In the last 3 years, four European studies reporting the test accuracy of routine pulse oximetry screening, and involving over 150 000 babies, have strengthened the argument. A systematic review and meta-analysis of almost 230 000 screened babies has also recently been published which reported high specificity, moderate sensitivity and a low false-positive rate. In addition, acceptability to parents and staff, cost-effectiveness and feasibility of implementing screening outside the research context have also been reported.
Pulse oximetry screening is a highly specific, moderately sensitive test, which is acceptable to parents and staff, likely to be cost-effective and fulfils the criteria for universal screening. Routine screening for CCHD using pulse oximetry is being increasingly supported and was added to the recommended uniform screening panel in the USA in 2011.

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    ABSTRACT: Pulse oximetry screening is a highly specific, moderately sensitive test for detecting critical congenital heart defects (CCHDs) that meets the criteria for universal screening. The possibility of using pulse oximetry as a screening test was first investigated over 10 years ago and since then data from more than 370,000 screened babies have now been published. There is significant heterogeneity in published screening protocols but almost all demonstrate that the addition of pulse oximetry screening reduces the 'diagnostic gap' - i.e. those babies with CCHD who are missed by existing screening methods and discharged from hospital before the diagnosis has been established. This review considers the available evidence and assesses the practical options for the introduction of pulse oximetry screening. © 2014 Elsevier Ireland Ltd. All rights reserved.
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