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Clinical Trial
. 2018 Jun:197:29-35.e1.
doi: 10.1016/j.jpeds.2018.01.039. Epub 2018 Mar 23.

Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge

Ilona C Narayen  1 , Nico A Blom  2 , Nan van Geloven  3 , Ellen I M Blankman  4 , Annique J M van den Broek  5 , Martijn Bruijn  6 , Sally-Ann B Clur  7 , Frank A van den Dungen  8 , Hester M Havers  9 , Henriëtte van Laerhoven  10 , Shahryar E Mir  11 , Moira A Muller  12 , Odette M Polak  13 , Lukas A J Rammeloo  14 , Gracita Ramnath  15 , Sophie R D van der Schoor  16 , Anton H van Kaam  17 , Arjan B Te Pas  18 ; POLAR study group
Collaborators, Affiliations
Clinical Trial

Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge

Ilona C Narayen et al. J Pediatr. 2018 Jun.

Abstract

Objective: To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives.

Study design: Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90% or if 2 independent measures of pre- and postductal SpO2 were <95% and/or the pre-/postductal difference was >3%. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses.

Results: The prenatal detection rate of CCHDs was 73%. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0% (95% CI 23.7-76.3) and specificity was 99.1% (95% CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61% (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2% (95% CI 56.0-81.4).

Conclusion: Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6% of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.

Keywords: cardiology; neonate; neonatology; newborn; pediatrics.

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