Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after birth in Buriram during 2018-2021
Keywords:
pulse oximetry, congenital heart disease, screeningAbstract
Background and Objective: Critical congenital heart disease has a high mortality rate. Therefore, a screening test was done by using a pulse oximetry to measure oxygen saturation in all infants within 24 hours to before discharge from hospital. The pulse oximetry screening had various sensitivity and specificity, depended on the studied populations. This study aimed to determine an accuracy of pulse oximetry for screening critical congenital heart disease in newborns in Buriram province and to find out the incidence and the clinical characteristics and symptoms of critical congenital heart disease patients.
Methods: Descriptive multicenter prospective diagnostic accuracy research study in the infants born in Buriram province between 1st June 2018- 31st July 2021, who were performed a pulse oximetry screening for critical congenital heart disease within 24 hours prior to discharge. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, percentage for the diagnosis of critical congenital heart disease were analyzed.
Results: The incidence of critical congenital heart disease was 1.6 per 1,000 live births. Pulse oximetry screening had sensitivity of 15.0 %, Specificity of 99.9%, accuracy of 99.9%, positive predictive value of 37.5%, and negative predictive value of 99.5% , positive likelihood ratio 1,023.7 and negative likelihood ratio 0.9. Thirty-three patients (62.3%) were clinically diagnosed before the pulse oximetry screening was performed, and 17 patients (32.1%) were later diagnosed despite the negative screening result. In patients with critical congenital heart disease, the clinical signs that were detected including heart murmur (64.1%), cyanosis (60.4%), tachypnea (56.6%), and shock (11.3%). There were 19 patients died (35.8%), of which 11 (20.1%) were diagnosed prior to the screening test, and 8 (15.1%) were diagnosed after the screening test. Neonatal mortality rate was 0.6 : 1,000 live births.
Conclusions: Pulse oximetry screening is low sensitive but highly specific to detect the patients. Conversely the screening test can not discrimination the patient with critical congenital heart disease from healthy infants. Therefore, medical personnel should closely observe clinical abnormalities that commonly found in critical congenital heart disease infants to promptly diagnose the disease.
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