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Screening for duct‐dependent congenital heart disease with pulse oximetry: A critical evaluation of strategies to maximize sensitivity
Author(s) -
GRANELLI ANNE DEWAHL,
MELLANDER MATS,
SUNNEGÅRDH JAN,
KENNETH SANDBERG,
ÖSTMANSMITH INGEGERD
Publication year - 2005
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2005.tb01834.x
Subject(s) - medicine , pulse oximetry , heart disease , cardiology , predictive value , referral , pediatrics , surgery , anesthesia , family medicine
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.