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Can J Cardiol. 2017 Feb;33(2):199-208. doi: 10.1016/j.cjca.2016.10.006. Epub 2016 Oct 26.

Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease.

Author information

1
Pediatric Cardiology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: kenny.wong@iwk.nshealth.ca.
2
Pediatric Cardiology, CHU Sainte-Justine, University of Montréal, Montréal, Québec, Canada.
3
Pediatric Cardiology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
4
Family Medicine, University of Toronto, Toronto, Ontario and WMU Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA.
5
Pediatric Cardiology, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
6
Neonatology, University of Manitoba, Winnipeg, Manitoba, Canada.
7
Pediatric Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Abstract

Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 newborns have critical congenital heart disease (CCHD). Timely diagnosis affects morbidity, mortality, and disability, and newborn pulse oximetry screening has been studied to enhance detection of CCHD. In this position statement we present an evaluation of the literature for pulse oximetry screening. Current detection strategies including prenatal ultrasound examination and newborn physical examination are limited by low diagnostic sensitivity. Pulse oximetry screening is safe, noninvasive, easy to perform, and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by screening after 24 hours, and testing the right hand and either foot might further increase sensitivity. Newborns with abnormal screening results should undergo a comprehensive assessment and echocardiography performed if a cardiac cause cannot be excluded. Screening has been studied to be cost neutral to cost effective. We recommend that pulse oximetry screening should be routinely performed in all healthy newborns to enhance the detection of CCHD in Canada.

PMID:
28043739
DOI:
10.1016/j.cjca.2016.10.006
[Indexed for MEDLINE]

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