The role of pulse oximetry in neonatal screening for critical and complex congenital heart defects

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Abstract

Background: Timely diagnosis of complex and critical congenital heart defects in neonates can help to avoid fatal complications of their natural history and to establish correct treatment strategies. Therefore, easily available and inexpensive screening methods for their routine diagnostics are important.

Aim: To demonstrate the role of pulse oximetry in the diagnosis of complex and critical congenital heart defects.

Materials and methods: Forty six neonates aged from 1 to 27 days with congenital heart defects, diagnosed after birth, were included into the study. Their diagnoses were verified by expert echocardiography performed after positive pulse oximetry test or due to unexplainable oxygen dependency and/or clinical manifestation of severe heart failure. The pulse oximetry test was considered positive with SaO2 < 95% in any extremity and the difference between the right hand and foot of above 3%.

Results: The pulse oximetry test was positive in all neonates with transposition of the great arteries (n = 5), hypoplastic left heart syndrome (n = 6), total anomalous pulmonary venous collection (n = 2), common arterial trunk (n = 3), pulmonary artery atresia with ventricular septum defect (n = 1). The pulse oximetry test was non-informative in those with obstructive abnormalities of the left heart, such as aortic valve stenosis and aortic coarctation.

Conclusion: The pulse oximetry test can be used for routine screening for complex and critical congenital heart defects in neonates.

About the authors

M. V. Tarayan

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: tarayan@mail.ru

MD, PhD, Cardiovascular Surgeon, Department of Pediatric Cardiac Surgery

61/2–5 Shchepkina ul., Moscow, 129110, Russian Federation. Tel.: +7 (916) 693 81 35

Russian Federation

A. I. Drozdova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, Pediatric Cardiologist, Department of Pediatric Cardiac Surgery

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Russian Federation

E. S. Efremov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, Cardiovascular Surgeon, Department of Cardiac Surgery

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Russian Federation

N. V. Shkarina

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, Pediatric Anesthesiologist, Department of Pediatric Intensive Care

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Russian Federation

L. V. Malyutina

Mytishchi Town Clinical Hospital

Email: fake@neicon.ru

MD, PhD, Anesthesiologist, Neonatologist, Neonatal Intensive Care Unit, Mytishchi Perinatal Center

24 Kominterna ul., g. Mytishchi, Moskovskaya oblast', 141009, Russian Federation

Russian Federation

References

  1. Botto LD, Correa A, Erickson JD. Racial and temporal variations in the prevalence of heart defects. Pediatrics. 2001;107(3):E32. doi: 10.1542/peds.107.3.e32.
  2. Talner CN. Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler, MD, Pediatrics, 1980;65(suppl):375–461. Pediatrics. 1998;102(1 Pt 2): 258–9.
  3. Heron MP, Smith BL. Deaths: leading causes for 2003. Natl Vital Stat Rep. 2007;55(10): 1–92.
  4. Rosano A, Botto LD, Botting B, Mastroiacovo P. Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health. 2000;54(9): 660–6. doi: http://dx.doi.org/10.1136/jech.54.9.660.
  5. Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation. 2001;103(19): 2376–81. doi: https://doi.org/10.1161/01.CIR.103.19.2376.
  6. Acharya G, Sitras V, Maltau JM, Dahl LB, Kaaresen PI, Hanssen TA, Lunde P. Major congenital heart disease in Northern Norway: shortcomings of pre- and postnatal diagnosis. Acta Obstet Gynecol Scand. 2004;83(12): 1124–9. doi: 10.1111/j.0001-6349.2004.00404.x.
  7. Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers. Heart. 2000;84(3): 294–8. doi: http://dx.doi.org/10.1136/heart.84.3.294.
  8. Klein SK, Cans C, Robert E, Jouk PS. Efficacy of routine fetal ultrasound screening for congenital heart disease in Isère County, France. Prenat Diagn. 1999;19(4): 318–22. doi: 10.1002/(SICI)1097-0223(199904)19:4<318::AIDPD538>3.0.CO;2-X.
  9. Randall P, Brealey S, Hahn S, Khan KS, Parsons JM. Accuracy of fetal echocardiography in the routine detection of congenital heart disease among unselected and low risk populations: a systematic review. BJOG. 2005;112(1): 24–30. doi: 10.1111/j.1471-0528.2004.00295.x.
  10. Tegnander E, Williams W, Johansen OJ, Blaas HG, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30,149 fetuses – detection rates and outcome. Ultrasound Obstet Gynecol. 2006;27(3): 252–65. doi: 10.1002/uog.2710.
  11. Westin M, Saltvedt S, Bergman G, Kublickas M, Almström H, Grunewald C, Valentin L. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36,299 fetuses. BJOG. 2006;113(6): 675–82. doi: 10.1111/j.1471-0528.2006.00951.x.
  12. Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart. 2006;92(9): 1298–302. doi: 10.1136/hrt.2005.078097.
  13. Aamir T, Kruse L, Ezeakudo O. Delayed diagnosis of critical congenital cardiovascular malformations (CCVM) and pulse oximetry screening of newborns. Acta Paediatr. 2007;96(8): 1146– 9. doi: 10.1111/j.1651-2227.2007.00389.x.
  14. Manja V, Mathew B, Carrion V, Lakshminrusimha S. Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit. J Perinatol. 2015;35(1): 67–71. doi: 10.1038/jp.2014.135.
  15. O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed. 2007;92(6):F465–7. doi: 10.1136/adc.2007.120634.
  16. Katzman GH. The newborn's SpO2: a routine vital sign whose time has come? Pediatrics. 1995;95(1): 161–2.
  17. O'Brien LM, Stebbens VA, Poets CF, Heycock EG, Southall DP. Oxygen saturation during the first 24 hours of life. Arch Dis Child Fetal Neonatal Ed. 2000;83(1):F35–8. doi: http://dx.doi.org/10.1136/fn.83.1.F35.
  18. Hoke TR, Donohue PK, Bawa PK, Mitchell RD, Pathak A, Rowe PC, Byrne BJ. Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study. Pediatr Cardiol. 2002;23(4): 403–9. doi: 10.1007/s00246-002-1482-8.
  19. Reich JD, Miller S, Brogdon B, Casatelli J, Gompf TC, Huhta JC, Sullivan K. The use of pulse oximetry to detect congenital heart disease. J Pediatr. 2003;142(3): 268–72. doi: 10.1067/mpd.2003.87.
  20. Koppel RI, Druschel CM, Carter T, Goldberg BE, Mehta PN, Talwar R, Bierman FZ. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics. 2003;111(3): 451–5. doi: 10.1542/peds.111.3.451.
  21. Levesque BM, Pollack P, Griffin BE, Nielsen HC. Pulse oximetry: what's normal in the newborn nursery? Pediatr Pulmonol. 2000;30(5): 406–12.
  22. Arlettaz R, Bauschatz AS, Mönkhoff M, Essers B, Bauersfeld U. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr. 2006;165(2): 94–8. doi: 10.1007/s00431-005-0006-y.
  23. Kawalec W, Blaz W, Turska-Kmiec A, Zuk M, Helwich E, Tobota Z. Pulse oximetry as a population screening test in detection of critical congenital heart disease in presymptomatic newborns: Polish multicenter study [Abstract]. Cardiol Young. 2006;16(Suppl 2): 25.
  24. Richmond S, Reay G, Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed. 2002;87(2):F83–8. doi: http://dx.doi.org/10.1136/fn.87.2.F83.
  25. Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol. 2005;26(6): 832–5. doi: 10.1007/s00246-005-0981-9.
  26. Rosati E, Chitano G, Dipaola L, De Felice C, Latini G. Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease. J Perinat Med. 2005;33(5): 455–7. doi: 10.1515/JPM.2005.080.
  27. Meberg A, Brügmann-Pieper S, Due R Jr, Eskedal L, Fagerli I, Farstad T, Frøisland DH, Sannes CH, Johansen OJ, Keljalic J, Markestad T, Nygaard EA, Røsvik A, Silberg IE. First day of life pulse oximetry screening to detect congenital heart defects. J Pediatr. 2008;152(6): 761–5. doi: 10.1016/j.jpeds.2007.12.043.
  28. de Wahl Granelli A, Mellander M, Sunnegårdh J, Sandberg K, Ostman-Smith I. Screening for duct-dependant congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity. Acta Paediatr. 2005;94(11): 1590–6.
  29. Liske MR, Greeley CS, Law DJ, Reich JD, Morrow WR, Baldwin HS, Graham TP, Strauss AW, Kavanaugh-McHugh AL, Walsh WF; Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease. Report of the Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease. Pediatrics. 2006;118(4):e1250–6. doi: 10.1542/peds.2005-3061.
  30. Ward CJ, Purdie J. Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists. J Paediatr Child Health. 2001;37(4): 331–6. doi: 10.1046/j.1440-1754.2001.00695.x.

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Copyright (c) 2017 Tarayan M.V., Drozdova A.I., Efremov E.S., Shkarina N.V., Malyutina L.V.

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