Document Type : original article
Authors
1 Associate Professor, Division of Neonatology, Department of Paediatrics, J.J.M Medical College, Davangere, Karnataka, India
2 Post Graduate, Department of Paediatrics, J.J.M Medical College, Davangere, Karnataka, India
3 Professor and Head, Department of Paediatrics, J.J.M Medical College, Davangere, Karnataka, India.
Abstract
Background: Congenital heart disease is the most common type of birth defect in infancy with incidence of 8 to 12 per 1000 live births in India. Pulse oximetry has emerged as a good screening tool in the recent past in many countries being noninvasive and cost effective. This study aimed at estimating the accuracy of pulse oximetry as a standard screening method to detect congenital heart diseases (CHD) in neonates.
Methods: This prospective observational study was conducted in a tertiary referral medical college hospital from December 2018 to June 2020. Pulse oximetry readings were taken of 1603 asymptomatic neonates breathing in room air from right hand and either foot after 24 hours of birth. Pulse oximetry was considered positive if oxygen saturation in room air measured <95% or difference between right hand and foot was more than 3% persistently for 3 readings as per the standard American Academy of Pediatrics algorithm. Neonates with positive pulse oximetry or those with persistent abnormal clinical examination underwent echocardiography.
Results: Of the term neonates (n=1603) screened, incidence of CHD was 0.7 per 1000 live births and critical CHD was 0.3 per 1000 live births. The sensitivity, specificity, positive predictive value, and negative predictive value of pulse oximetry to detect any CHD were 70.6%, 98.8%, 38.7%, and 99.7%, major CHD was found to be 60%, 98.4%, 19.4%, and 99.7%, and critical CHD to be 85.7%, 98.4%, 19.4%, and 99.9%, respectively. Pulse oximetry had significant positive correlation with abnormal clinical examination (R=0.29, p<0.001) and ECHO findings in detecting CHD (R=0.49, p<0.001). Regression model to evaluate whether abnormal clinical examination and positive pulse oximetry are significant predictors of CHD detected by ECHO was statistically significant (R2 =0.34, p value <0.001) and both were significant independent predictors (p<0.001).
Conclusion: Pulse oximetry screening is a useful tool for detecting congenital heart diseases in newborns.
Keywords
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