Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after birth in Buriram during 2018-2021

Authors

  • Katenipa Sinsupan กลุ่มงานกุมารเวชกรรม โรงพยาบาลบุรีรัมย์

Keywords:

pulse oximetry, congenital heart disease, screening

Abstract

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.

References

CDC. Critical Congenital Heart Defects in the United States | CDC [Internet]. Centers for Disease Control and Prevention. 2019 [cited Aug 11, 2022]. Available from: https://www.cdc.gov/ncbddd/heartdefects/features/cchd-keyfindings.html

Identifying newborns with critical congenital heart disease [Internet]. [cited Aug 11, 2022]. Available from: https://www.medilib.ir/uptodate/show/5774

Identifying newborns with critical congenital heart disease [Internet]. [cited Aug 11, 2022]. Available from: https://www.medilib.ir/uptodate/show/5774

CDC. Critical Congenital Heart Defects Screening Methodss | CDC [Internet]. Centers for Disease Control and Prevention. 2022 [cited Aug 11, 2022]. Available from: https://www.cdc.gov/ncbddd/heartdefects/hcp.html

Silberbach M, Hannon D. Presentation of congenital heart disease in the neonate and young infant. Pediatr Rev 2007;28(4):123–31.

Das BB. Patent Foramen Ovale in Fetal Life, Infancy and Childhood. Med Sci [Internet]. 2020;8(3):25. [cited Aug 11, 2022]. Available from: https://www.mdpi.com/2076-3271/8/3/25

Giblett JP, Williams LK, Kyranis S, Shapiro LM, Calvert PA. Patent Foramen Ovale Closure: State of the Art. Interv Cardiol Rev [Internet]. 2020;15:e15. [cited Aug 11, 2022]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726850/

Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation 2006;114(17):1873–82.

Slaughter JL, Cua CL, Notestine JL, Rivera BK, Marzec L, Hade EM, et al. Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation. BMC Pediatr [Internet]. 2019;19(1):333. [cited Aug 11,2022] Available from: https://doi.org/10.1186/s12887-019-1708-z

Gillam-Krakauer M, Mahajan K. Patent Ductus Arteriosus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited Aug 11, 2022]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK430758/

Arlettaz R, Archer N, Wilkinson AR. Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child - Fetal Neonatal Ed [Internet]. 1998;78(3):F166–70. [Cited Aug 11, 2022]. Available from: https://fn.bmj.com/content/78/3/F166

Hermes-DeSantis ER, Clyman RI. Patent ductus arteriosus: pathophysiology and management. J Perinatol [Internet]. 2006;26(1):S14–8. [cited Aug 11, 2022]. Available from: https://www.nature.com/articles/7211465

Conrad C, Newberry D. Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population. Adv Neonatal Care [Internet]. 2019;19(3):179–87. [cited Aug 11, 2022]. Available from: https://journals.lww.com/advancesinneonatalcare/Abstract/2019/06000/Understanding_the_Pathophysiology,_Implications,.4.aspx

Yuan Z, Zhang LZ, Li B, Chung HT, Jiang JX, Chiang JY, et al. Investigation of echocardiographic characteristics and predictors for persistent defects of patent foramen ovale or patent ductus arteriosus in Chinese newborns. Biomed J [Internet]. 2021;44(2):209–16. [cited Aug 11, 2022]. Available from: https://www.sciencedirect.com/science/article/pii/S2319417019305293

Bakker MK, Bergman JE, Krikov S, Amar E, Cocchi G, Cragan J, et al. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ Open 2019;9(7):e028139.

Tennant PW, Pearce MS, Bythell M, Rankin J. 20-year survival of children born with congenital anomalies: a population-based study. The Lancet [Internet]. 2010;375(9715):649–56. [cited Aug 11, 2022]. Available from: https://www.sciencedirect.com/science/article/pii/S014067360961922X

Zhao QM, Liu F, Wu L, Ma XJ, Niu C, Huang GY. Prevalence of Congenital Heart Disease at Live Birth in China. J Pediatr [Internet]. 2019;204:53–8. [cited Aug 11, 2022]. Available from: https://www.sciencedirect.com/science/article/pii/S0022347618312149

Górska-Kot A, Błaż W, Pszeniczna E, Rusin J, Materna-Kiryluk A, Homa E, et al. Trends in diagnosis and prevalence of critical congenital heart defects in the Podkarpacie province in 2002–2004, based on data from the Polish Registry of Congenital Malformations. J Appl Genet [Internet]. 2006;47(2):191–4. [cited Aug 11, 2022]. Available from: https://doi.org/10.1007/BF03194621

Effectiveness of Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Newborns | Pediatrics | American Academy of Pediatrics [Internet]. [cited Aug 11, 2022]. Available from: https://publications.aap.org/pediatrics/article-abstract/111/3/451/79832/Effectiveness-of-Pulse-Oximetry-Screening-for

Mai CT, Riehle-Colarusso T, O’Halloran A, Cragan JD, Olney RS, Lin A, et al. Selected Birth Defects Data from Population-based Birth Defects Surveillance Programs in the United States, 2005–2009: Featuring Critical Congenital Heart Defects Targeted for Pulse Oximetry Screening. Birt Defects Res A Clin Mol Teratol [Internet]. 2012;94(12):970–83. [cited Aug 11, 2022]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628831/

Olney RS, Botto LD. Newborn screening for critical congenital heart disease: Essential public health roles for birth defects monitoring programs. Birt Defects Res A Clin Mol Teratol [Internet]. 2012;94(12):965–9. [cited Aug 11, 2022]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/bdra.23103

Liberman RF, Getz KD, Lin AE, Higgins CA, Sekhavat S, Markenson GR, et al. Delayed diagnosis of critical congenital heart defects: trends and associated factors. Pediatrics 2014;134(2):e373-381.

Ailes EC, Gilboa SM, Honein MA, Oster ME. Estimated number of infants detected and missed by critical congenital heart defect screening. Pediatrics 2015;135(6):1000–8.

Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal Trends in Survival Among Infants With Critical Congenital Heart Defects. Pediatrics [Internet]. 2013;131(5):e1502–8. [cited Aug 11, 2022]. Available from: https://doi.org/10.1542/peds.2012-3435

Dastgiri S, Gilmour WH, Stone DH. Survival of children born with congenital anomalies. Arch Dis Child [Internet]. 2003;88(5):391–4. [cited Aug 11, 2022]. Available from: https://adc.bmj.com/content/88/5/391

Lopes SAV do A, Guimarães ICB, Costa SF de O, Acosta AX, Sandes KA, Mendes CMC. Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in Newborns. A Cohort Study. Arq Bras Cardiol [Internet]. 2018;111:666–73. [cited Aug 11, 2022]. Available from: http://www.scielo.br/j/abc/a/4zbVV8MP3jDWT9JTgq5zFXH/abstract/?lang=en

Mahle WT, Martin GR, Beekman RH III, Morrow WR, Rosenthal GL, et al. Endorsement of health and human services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics 2012;129(1):190–2.

Pulse oximetry screening for critical congenital heart defects - Plana, MN - 2018 | Cochrane Library [Internet]. [cited Aug 11, 2022]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011912.pub2/full

Henprasertthae S, Chaonarin P. Screening for critical congenital heart disease in Thai Neonates: single center study. Thai J Pediatr 2013. 2013;52:242-9.

Jirapradittha J, Ninwashararung N, Kiatchoosakun P, Chaikitpinyo A, Panamonta M. Critical congenital heart disease screening in neonates in Srinagarind hospital. Srinagarind Med J [Internet]. 2014;29(4):102–102. [cited Aug 11, 2022]. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/23705

Yongpradit J. Critical congenital heart disease screening in Neonatesin Sampran Hospital, Nakhon Pathom Province. Region 4-5 Med J [Internet]. 2016;35(4):249-58. [Cited Aug 11, 2022]. Available from: https://he02.tci-thaijo.org/index.php/reg45/article/view/124333

Thamjamratsri K, Prangvatanagul W. Critical Congenital Heart Disease Screening in Neonates in Prapokklao hospital. J Prapokklao Hosp Clin Med Educ Cent [Internet]. 2019;36(2):134–41. [cited Aug 11, 2022]. Available from: https://he02.tci-thaijo.org/index.php/ppkjournal/article/view/166569

Peterson C, Ailes E, Riehle-Colarusso T, Oster ME, Olney RS, Cassell CH, et al. Late detection of critical congenital heart disease among US infants: estimation of the potential impact of proposed universal screening using pulse oximetry. JAMA Pediatr 2014;168(4):361–70.

Iyer PU, Moreno GE, Caneo LF, Faiz T, Shekerdemian LS, Iyer KS. Management of late presentation congenital heart disease. Cardiology in the Young 2017;27(S6):S31-9.

Chang RKR, Gurvitz M, Rodriguez S. Missed diagnosis of critical congenital heart disease. Arch Pediatr Adolesc Med 2008;162(10):969–74.

Martin GR, Ewer AK, Gaviglio A, Hom LA, Saarinen A, Sontag M, et al. Updated strategies for pulse oximetry screening for critical congenital heart disease. Pediatrics 2020;146(1):e20191650.

Published

2022-12-22

How to Cite

1.
Sinsupan K. Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after birth in Buriram during 2018-2021. SRIMEDJ [Internet]. 2022 Dec. 22 [cited 2024 Jun. 15];37(6):576-87. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/253304

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