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Bild Congential Heart Disease

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					     Practical Feasibility of Screening for Critical
       Congenital Heart Disease in Newborns
                 With Pulse Oximetry
        A de-Wahl Granelli1, M Mellander1, J Sunnegårdh1, K Sandberg2, I Östman-Smith1
              Department of Paediatric Cardiology1, Department of Neonatology2,
                   The Queen Silvia Children’s Hospital, Göteborg, Sweden

                                                  Introduction
Many babies with duct-dependent critical congenital heart disease (CCHD) are not detected by routine neonatal
physical examination. There is a need for an additional tool to enable an early detection of CCHD. Our aim is to
define an optimal screening regime using pulse oximetry.
                                                     Methods
(A) In an initial case-control study, 200 normal newborns and 85 infants with CCHD were compared to calculate
optimal cut-off values. A pulse oximetry reading was obtained from the right hand and one foot using a new-
generation oximeter (NGoxi), Fig 1A and B. (B) Prospective screening of all babies in the newborn nurseries in our
region with NGoxi, using the defined cut-off from (A) but with introduction of three repeated positive measurements
into the protocol.




                                                  Fig 1 A and B

                                              Results (A)

                                       Positive screening
                                            criteria:
                                   <95% in both Right hand & foot
                                                 or
                                     hand-foot difference >+ 3%

                                           Sensitivity 98%
                                           Specificity 96%
                                      Positive Predictive Value 91%
                                      Negative Predictive Value 99%


 83/85 infants with CCHD were detected using NGoxi, including 9/11 infants with coarctation of the aorta (CoA).
 (B) Preliminary data from ongoing study on 8642 newborns show a significant reduction of the false positive rate
 from 4% to 0.14%. We have detected five out of six infants with duct-dependent CCHD, the false negative case
 had isolated CoA. Among the12 “false positive” cases we found one Ebstein anomaly, one AVSD, one Sinus
 venousus ASD, one infant with persistant fetal circulation and one with pneumothorax. All of them needed
 treatment.

                                                  Conclusion
   A pre- and postductal saturation screening with NGoxi before discharge from the newborn
 nurseries seems to be a promising tool to detect CCHD with a very low false positive rate. The
    study also detected infants suffering from other conditions, that also benefits from early

				
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posted:3/31/2011
language:English
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