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- Title
Screening for duct-dependant congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity.
- Authors
de Wahl Granelli, Anne; Mellander, Mats; Sunnegårdh, Jan; Sandberg, Kenneth; Ostman-Smith, Ingegerd
- Abstract
<bold>Aim: </bold>To evaluate the feasibility of detecting duct-dependent congenital heart disease before hospital discharge by using pulse oximetry.<bold>Design: </bold>Case-control study.<bold>Setting: </bold>A supra-regional referral centre for paediatric cardiac surgery in Sweden.<bold>Patients: </bold>200 normal term newborns with echocardiographically normal hearts (median age 1.0 d) and 66 infants with critical congenital heart disease (CCHD; median age 3 d).<bold>Methods: </bold>Pulse oximetry was performed in the right hand and one foot using a new-generation pulse oximeter (NGoxi) and a conventional-technology oximeter (CToxi).<bold>Results: </bold>With the NGoxi, normal newborns showed a median postductal saturation of 99% (range 94-100%); intra-observer variability showed a mean difference of 0% (SD 1.3%), and inter-observer variability was 0% (SD 1.5%). The CToxi recorded a significantly greater proportion of postductal values below 95% (41% vs 1%) in the normal newborns compared with NGoxi (p<0.0001). The CCHD group showed a median postductal saturation of 90% (45-99%) with the NGoxi. Analysis of distributions suggested a screening cut-off of <95%; however, this still gave 7/66 false-negative patients, all with aortic arch obstruction. Best sensitivity was obtained by adding one further criterion: saturation of <95% in both hand and foot or a difference of >+/-3% between hand and foot. These combined criteria gave a sensitivity of 98.5%, specificity of 96.0%, positive predictive value of 89.0% and negative predictive value of 99.5%.<bold>Conclusion: </bold>Systematic screening for CCHD with high accuracy requires a new-generation oximeter, and comparison of saturation values from the right hand and one foot substantially improves the detection of CCHD.
- Subjects
CONGENITAL heart disease diagnosis; COMPARATIVE studies; NEWBORN screening; RESEARCH methodology; MEDICAL cooperation; OXIMETRY; RESEARCH; EVALUATION research; RESEARCH bias; CASE-control method; RECEIVER operating characteristic curves
- Publication
Acta Paediatrica, 2005, Vol 94, Issue 11, p1590
- ISSN
0803-5253
- Publication type
journal article
- DOI
10.1080/08035250510039900