Pulse Oximetry Screening for Critical Congenital Heart Defects in Asymptomatic Newborn Babies: A Systemic Review and Meta-Analysis

Study Questions:

What are the sensitivity, specificity, and false-positive rates of pulse oximetry screening in asymptomatic newborns?

Methods:

A systematic review and meta-analysis was performed. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated for individual studies. Critical congenital heart defects were defined both as life-threatening duct-dependent lesions or infants having lesions resulting in death or need for cardiac surgery in the first 28 days of life.

Results:

A total of 13 studies enrolling 229,421 infants were included in the analysis. The overall sensitivity of pulse oximetry was 76.5% (95% CI, 67.7-83.5), while the overall specificity was 99.9% (95% CI, 99.7-99.9%). The false-positive rate was 0.14% (95% CI, 0.06-0.33%). The false-positive rate was lower when screening was performed after 24 hours of life.

Conclusions:

Pulse oximetry is highly specific with moderate sensitivity for the detection of critical congenital heart disease, meeting previously established criteria for universal screening.

Perspective:

This meta-analysis reinforces results of previous individual studies suggesting a role for universal screening for congenital heart disease with pulse oximetry. A major impediment to the universal implementation of pulse oximetry screening has been the concern for false-positive results. This meta-analysis confirms a low false-positive rate, especially when screening is performed after 24 hour hours of life. This study supports the use of widespread screening for congenital heart disease with pulse oximetry.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Infant, Newborn, Heart Defects, Congenital, Confidence Intervals, Cardiac Surgical Procedures, Pregnancy


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