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: 14.43). 09/2009; 120(5):447-58. DOI: 10.1161/CIRCULATIONAHA.109.192576
Source: PubMed


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.

Download full-text


Available from: Scott D Grosse, Jan 16, 2016
  • Source
    • "Pulse oximetry screening (POS) is a noninvasive, painless, inexpensive, and cost-effective method to screen for CCHD (Cuzzi & Bradshaw, 2011). Health care resources used to screen and evaluate newborns for CCHD far outweigh cost of late detection and infant death (Mahle et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine if there would be positive results from a second pulse oximetry screening (POS) completed for newborns at discharge at 28 to 48 hours of age in addition to the newborn POS completed at 24 to 25 hours of age. Design: Prospective descriptive research study. Setting: Rural, mid-Atlantic, 13-bed, level I hospital. Participants: Newborns (N = 1,002) at 35 weeks' gestation or older discharged from the newborn nursery. Methods: Registered nurses (RNs) performed POS at 24 to 25 hours of age (POS 1) and at discharge but less than 48 hours of age (POS 2). Data related to critical congenital heart defects were collected. Results: There were no positive POS results (O2 saturation ≤ 90%) at POS 1 or POS 2, and no additional diagnostic tests were ordered as a result of POS. Although one full-term newborn had negative results at POS 1 and POS 2, the RN identified a murmur, and a subsequent echocardiogram was used to detect tetralogy of Fallot and pulmonary atresia. The RNs detected concerning conditions in 14 newborns that resulted in 28 additional tests, including echocardiograms (9), chest x-ray imaging (8), laboratory testing (7), electrocardiograms (3), and ultrasound imaging (1). Conclusions: The POS-positive result rate was 0 for newborns at POS 1 and POS 2. Therefore, our study findings supported Maryland's mandate of one POS completed within 24 to 48 hours of birth. Nurses must continue to be vigilant about assessing newborns, including screening for critical congenital heart defects and congenital heart defects.
    Full-text · Article · Dec 2015 · Journal of Obstetric Gynecologic & Neonatal Nursing
  • Source
    • "A mean SpO 2 of 95.4 % at 24 hours of life from a population evaluated at 5300 ft. In general, the mean difference between SpO 2 measurements in the upper and lower extremities is < 1 % [7]. Certainly the distance between the finger and the toe is much larger than the average length of the pulmonary capillaries, absent the generation of oxygen through hemoglobin, SaO 2 should be close to 40 mm Hg in the extremities, since the distance to the heart of them is sufficient for oxygen concentration was significantly decreasing, and contradictorily remains at levels close to 95%, as if within the lung itself or the immediate, which contradicts the theory that only oxygen enters the blood through the pulmonary alveoli and on the other hand supports our finding that hemoglobin dissociates the water molecule, which explains in turn, the energy source of the erythrocyte, as this does not have mitochondria. "
    [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.
    Full-text · Article · Oct 2013
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A case study of an infant with interrupted aortic arch who was discharged from the newborn nursery is presented for root cause analysis and implementation of a modified pulse oximetry screening program at the parent institution where it was described. A rationale for modification of the American Academy of Pediatrics policy statement supporting universal pulse oximetry screening for congenital heart disease in the newborn is made.
    Full-text · Article ·
Show more