Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease A Scientific Statement From the American Heart Association and American Academy of Pediatrics

Circulation (Impact Factor: 14.95). 09/2009; 120(5):447-58. DOI: 10.1161/CIRCULATIONAHA.109.192576
Source: PubMed

ABSTRACT The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD).
A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours.
Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: It is possible that the contradictions that emerge when contrasting hypotheses about gas exchange in the lungs with different clinical and experimental findings in both pulmonary and systemic diseases can be solved if we modify in our mind the role of atmospheric oxygen as the main source of oxygen in the blood and take into account both the intrinsic property of melanin to dissociate and re-form the water molecule which is the true source of intracellular molecular oxygen and also the intrinsic property of hemoglobin to dissociate the water molecule that is a significant contributor of oxygen levels in blood. Recall that chlorophyll and hemoglobin are virtually identical, as is the Mg the prosthetic group in chlorophyll and Fe in hemoglobin; another difference is that chlorophyll has a non-polar end that serves to bind to the chloroplast.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A multistage network that will reduce the translational uncertainty of a one-dimensional object is presented. To implement this network, novel network structures like multiple-valued outputs, competition between links instead of nodes, and cooperation of signals at the links are used. The number of nodes and links needed to implement the architecture is small. If the input field consists of n cells, then the total number of cells needed is only O ( n ). The total number of connections needed is O ( n log n ). It is shown that size-invariant recognition can also be achieved if the input to the architecture is provided by a scale-sensitive network called a masking field
    Neural Networks, 1992. IJCNN., International Joint Conference on; 07/1992
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The field of pediatric cardiology is continually developing and now covers not only congenital and acquired heart disease in children but also congenital heart disease in adults and the prenatal diagnosis and prevention of heart disease. This review highlights new findings in the field of genetics, selected articles on the use of magnetic resonance imaging and multislice CT in diagnosis, and recent publications on electrophysiology and the surgical treatment of children and adults with congenital heart disease. In addition, the increasingly advanced use of mechanical assist devices as a bridge to heart transplantation in children is also discussed.
    Revista Espa de Cardiologia 01/2010; 63:29-39. DOI:10.1016/S0300-8932(10)70138-X · 3.34 Impact Factor