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Study recommends universal pulse oximetry for detecting congenital heart defects in newborns
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Newborn screening for life-threatening congenital heart defects using pulse oximetry was more accurate than other detection methods, according to results of a recently published meta-analysis.
“The findings of this meta-analysis provide compelling evidence for introduction of pulse oximetry as a screening method in clinical practice. The sensitivity of the test is higher than present strategies based on antenatal screening and clinical examination, and the false-positive rate is very low, especially when done after 24 hours of birth,” Shakila Thangaratinam, MD, of Queen Mary, University of London, said in a press release.
Searching the Medline, Embase, Cochrane Library and SciSearch databases, researchers found 12 cohort studies and one case-control study that assessed the accuracy of pulse oximetry in the detection of critical congenital heart defects. In all, the analysis included data for 229,421 asymptomatic newborns. Selected studies met the predefined criteria for population, tests and outcomes.
Study results showed pulse oximetry had a high specificity (99.9%) and moderately high sensitivity (76.5%) for detection of critical congenital heart defects. The overall false-positive rate was low (0.14%), but particularly low when pulse oximetry was done 24 hours after birth (0.05%) vs. within 24 hours of birth (0.5%). The false-positive rate increased when newborn babies suspected to have congenital heart defects were included.
In an accompanying editorial, Alex R. Kemper, MD, MPH, MS, of the department of pediatrics at Duke University, and Gerard R. Martin, MD, of the division of cardiology at the Children’s National Medical Center and George Washington University School of Medicine, said the next step is to “identify when a bedside screening test should be recommended for routine clinical care or as a component of newborn screening.
“The importance of this issue will grow as technology allows more screening tests, including those done as part of dried blood-spot newborn screening, to be done cheaply and accurately within individual nurseries,” Kemper and Martin wrote. “However, we expect the debate about whether pulse oximetry screening should be part of newborn screening or clinical care to continue until we have better ways to assess explicitly the economic and health outcomes of each approach.”
For more information:
Kemper AR. Lancet. 2012;doi:10.1016/S0140-6736(12)60242-6.
Thangaratinam S. Lancet. 2012;doi:10.1016/S0140-6736(12)60107-X.
Disclosure: The researchers and Drs. Kemper and Martin report no relevant financial disclosures.