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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 and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and 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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