Cochrane for Clinicians
Putting Evidence into Practice
Pulse Oximetry Screening for Critical Congenital Heart Defects in Newborns
Am Fam Physician. 2019 Apr 1;99(7):421-422.
Author disclosure: No relevant financial affiliations.
Is pulse oximetry a diagnostically accurate screening test for critical congenital heart defects in newborns?
Pulse oximetry is an accurate screening test for critical congenital heart defects in newborns. Pulse oximetry is simple to use, widely available, and has moderate sensitivity (76.3%) and good specificity (99.9%). However, the prevalence of critical congenital heart defects is low, and most newborns who screen positive do not have a critical congenital heart defect.1 (Strength of Recommendation: B, based on limited-quality patient-oriented evidence.)
Congenital heart defects occur in approximately 1% of live births in the United States. About 25% of those newborns are considered to have a critical congenital heart defect.2 Mortality rates vary by the exact diagnosis but range as high as 30% and are likely decreased with early detection.3,4 Because most critical congenital heart defects are amenable to treatment, and newborns with these types of heart defects are usually asymptomatic, a good screening test may decrease mortality. The purpose of this Cochrane review was to determine the accuracy of pulse oximetry as a screening test for critical congenital heart defects.1
This Cochrane review examined 19 cohort and cross-sectional studies of low to moderate quality with 436,758 asymptomatic term or late preterm newborns who received screening in a newborn nursery setting.1 Newborns who were screened at home or in the neonatal intensive care unit were excluded from the review. The studies were spread across 13 countries, with only two from the United States. Each of the studies in the United States included a cohort of approximately 10,000 to 15,000 newborns and lacked adequate follow-up.
Eleven studies measured oxygen saturation in the foot alone (postductal), and eight studies measured it in the hand and foot (preductal and postductal). Eight studies measured the oxygen saturation within 24 hours of life, and
The practice recommendations in this activity are available at http://www.cochrane.org/CD011912.
Referencesshow all references
1. Plana MN, Zamora J, Suresh G, Fernandez-Pineda L, Thangaratinam S, Ewer AK. Pulse oximetry screening for critical congenital heart defects. Cochrane Database Syst Rev. 2018;(3):CD011912....
2. Centers for Disease Control and Prevention. Data and statistics on congenital heart defects. November 2, 2018. https://www.cdc.gov/ncbddd/heartdefects/data.html. Accessed August 12, 2018.
3. Kuehl KS, Loffredo CA, Ferencz C. Failure to diagnose congenital heart disease in infancy. Pediatrics. 1999;103(4 pt 1):743–747.
4. Chang RK, Gurvitz M, Rodriguez S. Missed diagnosis of critical congenital heart disease. Arch Pediatr Adolesc Med. 2008;162(10):969–974.
5. American Academy of Pediatrics. Newborn screening for critical congenital heart disease (CCHD)—2016 state actions. August 9, 2016. https://www.aap.org/en-us/Documents/2016_CCHD_Newborn_Screening_State_Actions.pdf. Accessed August 12, 2018.
6. Abouk R, Grosse SD, Ailes EC, Oster ME. Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths [published correction appears in JAMA. 2018;320(12):1288]. JAMA. 2017;318(21):2111–2118.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
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