Screening for duct-dependent congenital heart disease with pulse oximetry: A critical evaluation of strategies to maximize sensitivity

  1. ANNE DE-WAHL GRANELLI,
  2. MATS MELLANDER,
  3. JAN SUNNEGÅRDH,
  4. KENNETH SANDBERG &,
  5. INGEGERD ÖSTMAN-SMITH*

Article first published online: 2 JAN 2007

DOI: 10.1111/j.1651-2227.2005.tb01834.x

Issue

Acta Paediatrica

Acta Paediatrica

Volume 94, Issue 11, pages 1590–1596, November 2005

Additional Information

How to Cite

GRANELLI, A. D.-W., MELLANDER, M., SUNNEGÅRDH, J., &, K. S. and ÖSTMAN-SMITH, I. (2005), Screening for duct-dependent congenital heart disease with pulse oximetry: A critical evaluation of strategies to maximize sensitivity. Acta Paediatrica, 94: 1590–1596. doi: 10.1111/j.1651-2227.2005.tb01834.x

Author Information

  1. Department of Paediatrics, Institute of Women's and Children's Health, The Sahlgren Academy, University of Gothenburg, Gothenburg, Sweden

* Ingegerd Östman-Smith, Department of Paediatrics, The Queen Silvia Children's Hospital, SE-416 85 Gothenburg, Sweden. Tel: +46 31 3434512. Fax: +46 31 3435947. E-mail: ingegerd.ostman-smith@pediat.gu.se

Publication History

  1. Issue published online: 2 JAN 2007
  2. Article first published online: 2 JAN 2007
  3. (Received 1 December 2004; revised 5 April 2005; accepted 25 April 2005)

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Keywords:

  • Congenital heart defect;
  • duct dependent;
  • newborn examination;
  • pulse oximetry;
  • screening

Abstract

Aim: To evaluate the feasibility of detecting duct-dependent congenital heart disease before hospital discharge by using pulse oximetry. Design: Case-control study. Setting: A supra-regional referral centre for paediatric cardiac surgery in Sweden. Patients: 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).

Methods: Pulse oximetry was performed in the right hand and one foot using a new-generation pulse oximeter (NGoxi) and a conventional-technology oximeter (CToxi).

Results: 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%.

Conclusion: 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.

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