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image of The Role of Newborn Pulse Oximetry Screening for Detecting Critical Congenital Heart Defects: A Narrative Review

Abstract

Critical congenital heart diseases are life-threatening, with a high morbidity rate and mortality among newborns; in fact, a newborn discharged from the hospital with undiagnosed heart disease may experience severe complications during the initial days or weeks of their life, necessitating emergency care and even death. Among all kinds of critical congenital heart disease, coarctation of the aorta is one of the most difficult to diagnose because it only becomes noticeable a few days after birth, when patients have already been discharged from the hospital. This underlines the importance of having a reliable diagnostic tool to discover these diseases. The identification of some of these patients can be achieved through newborn screening with pulse oximetry, but only a small number are diagnosed.

Hence, the objective of this review was to determine the value of pulse oximetry screening for the early detection of congenital heart defects in newborns, with a focus on coarctation of the aorta. A literature search was conducted between December 2023 and February 2024 using four electronic databases: Pubmed, Google Scholar, Embase, and Scopus to identify studies that evaluated the efficacy of pre- and post-discharge neonatal ductal saturation monitoring for the diagnosis of critical congenital heart defects before discharge.

Twenty research studies with a large number of patients, demonstrating moderate sensitivity and high specificity of pulse oximetry test in detecting critical heart defects, especially coarctation of the aorta, were selected and analyzed.

Many confirmations have been found of how good the specificity of screening is, reaching an average value of 99.9% in each study analyzed. The problem still lies in the sensitivity of the screening, which is not as good as the specificity, never reaching 90% in any of the studies analysed. So, it is crucial to keep up with efforts to improve the efficacy of the pulse oximetry screening method.

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2024-10-31
2025-01-19
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References

  1. Perrone S Giordano M De Bernardo G Peripheral saturation and perfusion index on the first day of life play a role in early discharge of healthy term newborns. Int J Clin Pract 2022 2887312 10.1155/2022/2887312
    [Google Scholar]
  2. Respondek-Liberska M. Atlas of congenital heart disease. Lodz Adi Art 2011
    [Google Scholar]
  3. Taksande A. Jameel P.Z. Critical congenital heart disease in Neonates: A review article. Curr. Pediatr. Rev. 2021 17 2 120 126 10.2174/1573396317666210219162515 33605861
    [Google Scholar]
  4. Cardiopatie congenite. IRCCS materno infantile Burlo Garofolo 2024 Available from https://www.burlo.trieste.it/cardiopatie-congenite
  5. Willim H.A. Cristianto Alice Inda Supit Critical congenital heart disease in newborn: Early detection, diagnosis, and management. J. Biomed. Transl. Res. 2020 5 1 107 116 10.32539/bsm.v5i1.180
    [Google Scholar]
  6. Dolbec K Mick NW Congenital heart disease. Emerg Med Clin North Am 2011 29 4 811 827 10.1016/j.emc.2011.08.005
    [Google Scholar]
  7. Bakker MK Bergman JEH Krikov S Prenatal diagnosis, and prevalence of critical congenital heart defects: An international retrospective cohort study. BMJ Open. 2019 9 7 e028139 10.1136/bmjopen‑2018‑028139
    [Google Scholar]
  8. Kim Y.Y. Andrade L. Cook S.C. Aortic Coarctation. Cardiol. Clin. 2020 38 3 337 351 10.1016/j.ccl.2020.04.003 32622489
    [Google Scholar]
  9. Hoffman J.i.e. The challenge in diagnosing coarctation of the aorta. Cardiovasc. J. Afr. 2018 29 4 252 255 10.5830/CVJA‑2017‑053 29293259
    [Google Scholar]
  10. Abbruzzese P.A. Aidala E. Aortic coarctation: An overview. J. Cardiovasc. Med. (Hagerstown) 2007 8 2 123 128 10.2459/01.JCM.0000260215.75535.64 17299295
    [Google Scholar]
  11. van Velzen C.L. Ket J.C.F. van de Ven P.M. Blom N.A. Haak M.C. Systematic review and meta-analysis of the performance of second-trimester screening for prenatal detection of congenital heart defects. Int. J. Gynaecol. Obstet. 2018 140 2 137 145 10.1002/ijgo.12373 29094357
    [Google Scholar]
  12. Severinghaus J.W. Honda Y. History of blood gas analysis. VII. Pulse oximetry. J. Clin. Monit. 1987 3 2 135 138 10.1007/BF00858362 3295125
    [Google Scholar]
  13. Argun M. Sunkak S. Elmalı F. Keskin Ş. Narin N. Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns. Cardiol. Young 2023 33 7 1092 1096 10.1017/S1047951123002469 37458250
    [Google Scholar]
  14. Hua W. Niu C. Xuan Y. Zhao Q. Ren Y. Hu X. Wang Z. Sun J. Yangjin G. Dou Y. Yan W. Hu X. Huang G. Peripheral perfusion index in well newborns at 6 to 72 h of life at different altitudes: A multi-center study in China. Eur. J. Pediatr. 2022 182 2 907 915 10.1007/s00431‑022‑04725‑z 36525095
    [Google Scholar]
  15. Uygur O. Koroglu O.A. Levent E. Tosyali M. Akisu M. Yalaz M. Kultursay N. The value of peripheral perfusion index measurements for early detection of critical cardiac defects. Pediatr. Neonatol. 2019 60 1 68 73 10.1016/j.pedneo.2018.04.003 29776787
    [Google Scholar]
  16. Corsini I Cecchi A Coviello C Dani C Perfusion index and left ventricular output correlation in healthy term infants Eur J Pediatr. 2017 176 8 1013 1018 10.1007/s00431‑017‑2939‑3
    [Google Scholar]
  17. Granelli A.W. Östman-Smith I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr. 2007 96 10 1455 1459 10.1111/j.1651‑2227.2007.00439.x 17727691
    [Google Scholar]
  18. Meberg A. The value of pulse oximetry as a screening tool for congenital heart disease. Curr. Treat. Options Pediatr. 2015 1 3 202 210 10.1007/s40746‑015‑0020‑x
    [Google Scholar]
  19. Mahle W.T. Martin G.R. Beekman R.H. III Morrow W.R. Rosenthal G.L. Snyder C.S. Minich L.L.A. Mital S. Towbin J.A. Tweddell J.S. Section on Cardiology and Cardiac Surgery Executive Committee Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics 2012 129 1 190 192 10.1542/peds.2011‑3211 22201143
    [Google Scholar]
  20. Zhao Q. Ma X. Ge X. Liu F. Yan W. Wu L. Ye M. Liang X. Zhang J. Gao Y. Jia B. Huang G. Neonatal Congenital Heart Disease screening group Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet 2014 384 9945 747 754 10.1016/S0140‑6736(14)60198‑7 24768155
    [Google Scholar]
  21. de-Wahl Granelli A. Wennergren M. Sandberg K. Mellander M. Bejlum C. Inganäs L. Eriksson M. Segerdahl N. Agren A. Ekman-Joelsson B.M. Sunnegårdh J. Verdicchio M. Ostman-Smith I. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: A Swedish prospective screening study in 39 821 newborns. BMJ 2009 338 jan08 2 a3037 10.1136/bmj.a3037 19131383
    [Google Scholar]
  22. Prudhoe S. Abu-Harb M. Richmond S. Wren C. Neonatal screening for critical cardiovascular anomalies using pulse oximetry. Arch. Dis. Child. Fetal Neonatal Ed. 2013 98 4 F346 F350 10.1136/archdischild‑2012‑302045 23341250
    [Google Scholar]
  23. Mahle W.T. Newburger J.W. Matherne G.P. Smith F.C. Hoke T.R. Koppel R. Gidding S.S. Beekman R.H. III Grosse S.D. American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, and Committee on Fetus and Newborn 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 2009 120 5 447 458 10.1161/CIRCULATIONAHA.109.192576 19581492
    [Google Scholar]
  24. Riede F.T. Wörner C. Dähnert I. Möckel A. Kostelka M. Schneider P. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine—results from a prospective multicenter study. Eur. J. Pediatr. 2010 169 8 975 981 10.1007/s00431‑010‑1160‑4 20195633
    [Google Scholar]
  25. Govindaswami B. Jegatheesan P. Song D. Oxygen saturation screening for critical congenital heart disease. Neoreviews 2012 13 12 e724 e731 10.1542/neo.13‑12‑e724
    [Google Scholar]
  26. Thangaratinam S. Brown K. Zamora J. Khan K.S. Ewer A.K. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: A systematic review and meta-analysis. Lancet 2012 379 9835 2459 2464 10.1016/S0140‑6736(12)60107‑X 22554860
    [Google Scholar]
  27. Mellander M. Diagnosis and management of life-threatening cardiac malformations in the newborn. Semin. Fetal Neonatal Med. 2013 18 5 302 310 10.1016/j.siny.2013.04.007 23688937
    [Google Scholar]
  28. Ewer A.K. Review of pulse oximetry screening for critical congenital heart defects in newborn infants. Curr. Opin. Cardiol. 2013 28 2 92 96 10.1097/HCO.0b013e32835d7e42 23381095
    [Google Scholar]
  29. Özalkaya E. Akdağ A. Şen I. Cömert E. Melek Yaren H. Early screening for critical congenital heart defects in asymptomatic newborns in Bursa province. J. Matern. Fetal Neonatal Med. 2016 29 7 1105 1107 10.3109/14767058.2015.1035642 25902399
    [Google Scholar]
  30. Engel M. Kochilas L. Pulse oximetry screening: A review of diagnosing critical congenital heart disease in newborns. Med. Devices (Auckl.) 2016 9 199 203 10.2147/MDER.S102146 27468253
    [Google Scholar]
  31. Wong K.K. Fournier A. Fruitman D.S. Graves L. Human D.G. Narvey M. Russell J.L. Canadian cardiovascular society/canadian pediatric cardiology association position statement on pulse oximetry screening in newborns to enhance detection of critical congenital heart disease. Can. J. Cardiol. 2017 33 2 199 208 10.1016/j.cjca.2016.10.006 28043739
    [Google Scholar]
  32. Du C. Liu D. Liu G. Wang H. A meta-analysis about the screening role of pulse oximetry for congenital heart disease. BioMed Res. Int. 2017 2017 1 6 10.1155/2017/2123918 29376068
    [Google Scholar]
  33. Narayen I.C. Blom N.A. van Geloven N. Blankman E.I.M. van den Broek A.J.M. Bruijn M. Clur S.A.B. van den Dungen F.A. Havers H.M. van Laerhoven H. Mir S.E. Muller M.A. Polak O.M. Rammeloo L.A.J. Ramnath G. van der Schoor S.R.D. van Kaam A.H. te Pas A.B. van den Akker E.S.A. van den Berg E. de Boer M.A. Bouwmeester S. van Dorp M.C. de Graaf I.M. Haak M.C. Hermsen B.B.J. Hummel P. Kok B. Medema T.J. Mérelle M.E. Mooren G.C.A.H.C.N. Onland W. Pernet P.J. von Rosenstiel I.A. Schrijver-Levie N. Six S. Williams J.M. POLAR study group Accuracy of pulse oximetry screening for critical congenital heart defects after home birth and early postnatal discharge. J. Pediatr. 2018 197 29 35.e1 10.1016/j.jpeds.2018.01.039 29580679
    [Google Scholar]
  34. Plana M.N. Zamora J. Suresh G. Fernandez-Pineda L. Thangaratinam S. Ewer A.K. Pulse oximetry screening for critical congenital heart defects. Cochrane Libr. 2018 2018 3 CD011912 10.1002/14651858.CD011912.pub2 29494750
    [Google Scholar]
  35. Gopalakrishnan S. Karmani S. Pandey A. Singh N. Ratheesh Kumar J. Praveen R. Sodhi K. Pulse oximetry screening to detect critical congenital heart diseases in asymptomatic neonates. Med. J. Armed Forces India 2021 77 2 214 219 10.1016/j.mjafi.2020.09.004 33867640
    [Google Scholar]
  36. Sorensen MW Sadiq I Clifford GD Maher KO Oster ME Using pulse oximetry waveforms to detect coarctation of the aorta. Biomed Eng Online 2020 19 1 31 10.1186/s12938‑020‑00775‑2
    [Google Scholar]
  37. Martin G.R. Ewer A.K. Gaviglio A. Hom L.A. Saarinen A. Sontag M. Burns K.M. Kemper A.R. Oster M.E. Updated strategies for pulse oximetry screening for critical congenital heart disease. Pediatrics 2020 146 1 e20191650 10.1542/peds.2019‑1650 32499387
    [Google Scholar]
  38. Perrone S Giordano M De Bernardo G Management of oxygen saturation monitoring in preterm newborns in the NICU: The Italian picture. Ital J Pediatr 2021 47 1 20191650 10.1186/s13052‑021‑01050‑3
    [Google Scholar]
  39. Singh Y. Chen S.E. Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit. Eur. J. Pediatr. 2022 181 2 813 821 10.1007/s00431‑021‑04275‑w 34618229
    [Google Scholar]
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  • Article Type:
    Review Article
Keywords: CCHD ; coarctation of aorta ; oxygen ; screening ; Pulse oximetry ; newborn
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