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J Pediatr. 2018 Jun;197:29-35.e1. doi: 10.1016/j.jpeds.2018.01.039. Epub 2018 Mar 23.

Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge.

Author information

1
Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: i.c.narayen@lumc.nl.
2
Department of Paediatrics, Division of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
4
Department of Paediatrics, BovenIJ Hospital, Amsterdam, The Netherlands.
5
Department of Paediatrics, Alrijne Hospital, Leiden, The Netherlands.
6
Department of Paediatrics, Northwest Clinics, Alkmaar, The Netherlands.
7
Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
8
Department of Paediatrics, Division of Neonatology, Vrije Universiteit (VU) Medical Center, Amsterdam, The Netherlands.
9
Department of Paediatrics, Alrijne Hospital, Leiderdorp, The Netherlands.
10
Department of Paediatrics, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands.
11
Deparment of Paediatrics, Waterland Hospital, Purmerend, The Netherlands.
12
Department of Obstetrics, Spaarne Gasthuis, Hoofddorp, The Netherlands.
13
Department of Obstetrics, Amstelland Hospital, Amstelveen, The Netherlands.
14
Department of Paediatrics, Division of Pediatric Cardiology, Vrije Universiteit (VU) Medical Center, Amsterdam, The Netherlands.
15
Department of Paediatrics, Spaarne Gasthuis, Haarlem, The Netherlands.
16
Department of Paediatrics, Onze Lieve Vrouwe Gasthuis Oost, Amsterdam, The Netherlands.
17
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
18
Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
19
Department of Obstetrics, OLVG Oost, Amsterdam, The Netherlands.
20
Department of obstetrics, Waterland Hospital, Purmerend, The Netherlands.
21
Department of Obstetrics, VU Medical Center, Amsterdam, The Netherlands.
22
Midwifery Collaboration Network Haarlem/Hoofddorp, Haarlem, The Netherlands.
23
Midwifery Collaboration Network Leiden, Leiden, The Netherlands.
24
Department of Obstetrics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
25
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
26
Department of Obstetrics, OLVG West, Amsterdam, The Netherlands.
27
Department of Obstetrics, Gynaecology and Reproductive Medicine, Northwest Clinics Alkmaar, Alkmaar, The Netherlands.
28
Midwifery Collaboration Network Alkmaar, Alkmaar, The Netherlands.
29
Department of Obstetrics, BovenIJ Hospital, Amsterdam, The Netherlands.
30
Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands.
31
Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
32
Department of of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
33
Department of Obstetrics, Spaarne Gasthuis, Haarlem, The Netherlands.
34
Department of Pediatrics, Slotervaart Hospital, Amsterdam, The Netherlands.
35
Department of Pediatrics, Amstelland Hospital, Amstelveen, The Netherlands.
36
Midwifery Collaboration Network Amsterdam, Amsterdam, The Netherlands.
37
Department of Obstetrics, Alrijne Hospital, Leiden,The Netherlands.

Abstract

OBJECTIVE:

To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives.

STUDY DESIGN:

Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90% or if 2 independent measures of pre- and postductal SpO2 were <95% and/or the pre-/postductal difference was >3%. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses.

RESULTS:

The prenatal detection rate of CCHDs was 73%. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0% (95% CI 23.7-76.3) and specificity was 99.1% (95% CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61% (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2% (95% CI 56.0-81.4).

CONCLUSION:

Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6% of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.

KEYWORDS:

cardiology; neonate; neonatology; newborn; pediatrics

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