Abstract Ref Number = APCP143
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Pulse Oximetry Screening of the Newborn for Cyanotic Congenital Heart Disease
Congenital Heart Disease (CHD) is the most common congenital malformation with a prevalence of approximately 8-12 per 1000 newborns, and approximately 25% have critical CHD. Timely diagnosis affects morbidity, mortality, and disability.Newborn pulse oximetry screening has been studied to enhance the detection of hypoxemia in CHD. Most consistently cyanotic CHD detectable using pulse oximetry screening include hypoplastic left heart syndrome, pulmonary atresia intact ventricular septum, transposition of the great arteries, total anomalous pulmonary venous return, Tetralogy of Fallot, tricuspid atresia, and truncus arteriosus. Pulse oximetry screening is safe, noninvasive, easy to perform,and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%).It can detect levels of hypoxemia otherwise undetectable on clinical examination. Sensitivity increased to 93% when using the combination of pulse oximetry and clinical examination, compared to either pulse oximetry alone (84%) or physical examination alone (77%). The false-positive rate for detection was lower when pulse oximetry was performed longer than 24 hours after birth than when it was performed within 24 hours (0.06%, 95% CI 0.03 to 0.13, vs 0.42%, 95% CI 0.20 to 0.89; P = 0.027). A motion-tolerant pulse oximeter should be used. Criteria for a positive screen using American Academy of Pediatrics algorithm include any of the following: SpO2measurement of <90% in either extremity; SpO2 measurement of 90-94% in both right hand and foot on 3 measurements each separate by one hour; or SpO2 difference of >3% between right hand and footon 3 measurements each separate by one hour. Use of lower SpO2 limits will decrease the sensitivity and increase the false negative rate. A neonate with positive screen results should undergo evaluation to identify the cause of hypoxemia. Besides cyanotic CHD, other causes of hypoxemia include sepsis, RDS, PPHN, meconium aspiration, pneumonia and pneumothorax. If there is clinical suspicion for CHD, additional evaluation should be pursued even in the setting of a normal pulse oximetry result. In conclusion, newborn pulse oximetry screening should be routinely performed in addition to physical examinationto enhance the detection of cyanotic CHD and other hypoxemic conditions, before discharge from the well-baby nursery.
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