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Indian Pediatr 2015;52:
626 |
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Pulse Oximetry Screening of Critical
Congenital Heart Disease
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Althaf Ansary
Department of Neonatology, Royal Hospital for Sick
Children (Yorkhill), Dalnair Street, Glasgow, UK.
Email:
[email protected]
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The recent journal club article on pulse oximetry screening of critical
congenital heart disease (CHD) in neonates [1] brings an important issue
into a sharp focus. In the context of operational setting, the main
barriers referred to were: false positive rates, lack of availability of
echocardiography services, and lack of immediate palliative or
corrective interventions. I wish to add the following comments:
1. False-positive rates: A recent
systematic review [2] has shown that the false-positive rate for
detection of critical CHD was significantly low when pulse oximetry
was done after 24 h from birth than when it was done before 24 h
(0.05% vs. 0.5%). Moreover, most screening studies have
reported that a significant proportion of the false-positive babies
(between 37% and 70%) had a serious non-cardiac condition [3,4]. The
early identification of conditions such as pneumonia and infection,
before the baby becomes unwell, may represent a ‘secondary target’
for screening and be an important additional advantage of the test.
2. Lack of availability of echocardiography:
A low saturation screen is not a trigger for an immediate
referral for echocardiography. Rather, it should trigger an
experienced clinical review, appropriate investigation and possibly
a period of observation. Only, if the clinical pointers are towards
CHD a referral for echocardiography would be warranted. Despite
having access for an on-site echocardio-graphy, recent
post-implementation reviews [3,5] of this screening program reported
only minimal extra burden to this service.
3. Lack of immediate palliative or corrective
interventions: Pediatric cardiac intervention setups may
be suboptimal in developing countries, but early identification of
the babies with critical CHD before they collapse or become acidotic
will definitely improve their outcome if treatment is available.
Moreover, accurate diagnosis of the condition may have implications
for future pregnancies.
This screening practice should be seen as a test of
neonatal well-being and not just for critical CHD. This should become a
standard of care, especially in regions with poor prenatal diagnostic
infrastructure.
References
1. Mathew JL, Chawla D, Kumar D. How useful is pulse
oximetry for screening of congenital heart disease in newborns? Indian
Pediatr. 2014;51:913-5.
2. Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer
AK. Pulse oximetry screening for critical congenital heart defects in
asymptomatic newborn babies: A systematic review and meta-analysis.
Lancet. 2012; 379:2459-64.
3. Singh A, Rasiah SV, Ewer AK. The impact of routine
predischarge pulse oximetry screening in a regional neonatal unit. Arch
Dis Child Fetal Neonatal Ed. 2014; 99:F297-302.
4. Ewer AK, Middleton LJ, Furmston AT, Bhoyar A,
Daniels JP, Thangaratinam S, et al. Pulse oximetry as a screening
test for congenital heart defects in newborn infants (PulseOx): A test
accuracy study. Lancet. 2011;378:785-94.
5. Bhola K, Kluckow M, Evans N. Post-implementation
review of pulse oximetry screening of well newborns in an Australian
tertiary maternity hospital. J Paediatr Child Health. 2014;50:920-5.
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