Pulse Oximetry Screening Results at a Tertiary Care Center in Central-Antolia, Turkey

Abstract

Purpose: To evaluate the results of the pulse oximeter screening for the early diagnosis of critical congenital heart defects in newborns in our hospital and to share our results before the implementation of a nationwide screening program. Methods: This was a retrospective study on 2261 infants between April 2018 and January 2020. Right-hand for preductal measurement and right or left foot for post-ductal measurement were measured using Nellcor pulse-oximetry (Covidien, MA, USA). Results: In 2261 newborns, the average birth week of 2261 infants was 38.05±1.32 weeks and 3204.21±478.28 g birth weight. The mean screening time was 25.9±7.3 hours (median 25 hours; min–max 7–96 hours). The mean values of the pre-ductal and post-ductal measurements of the infants who passed the test at the first measurement were 96.46±1.65 and saturation 95.99±1.49. 2247 (99.38%) of the infants included in the study underwent screening, 14 (0.61%) could not pass. Overall test false positive rate was 0.6% for critical congenital heart defects. Critical congenital heart defects was not seen in any of those who could not pass the scan. Sensitivity and positive predictive value could not be calculated, as no critical congenital heart defects case was detected. Specificity and negative predictive value of the pulse-oximetry test were 99.3% and 100% respectively. Conclusion: We highlight that screening with pulse-oximetry should be popularized particularly in peripheral regions providing secondary health care services. We are of the opinion that screening of critical congenital heart defects with pulse-oximetry should be included in the national screening program in our country.

Keywords

• Pulse-oximetry screening,
• Critical congenital heart defects,
• Turkey

Project Number

Ethics Committee approval for this study was obtained from Necmettin Erbakan University with the Ethics Committee decision number of 2020/2333.

İç Anadolu'da Üçüncü Basamak Bir Merkezde Nabız Oksimetresi Tarama Sonuçları

Abstract

Amaç: Hastanemizdeki yenidoğanlarda kritik konjenital kalp defektlerinin erken tanısı için nabız oksimetresi taramasının sonuçlarını değerlendirmek ve ülke çapında bir tarama programı uygulanmadan önce sonuçlarımızı paylaşmak. Yöntemler: Bu, Nisan 2018 ile Ocak 2020 arasında 2261 bebek üzerinde yapılan retrospektif bir çalışmadır. Predüktal ölçüm için sağ taraf, duktal sonrası ölçüm için sağ veya sol ayak Nellcor nabız oksimetresi (Covidien, MA, ABD) kullanılarak ölçüldü. Bulgular: 2261 yenidoğanda 2261 bebeğin ortalama doğum haftası 38.05 ± 1.32 hafta ve doğum kilosu 3204.21 ± 478.28 g idi. Ortalama tarama süresi 25.9 ± 7.3 saat idi (medyan 25 saat; min – maks 7-96 saat). İlk ölçümde testi geçen bebeklerin preduktal ve postduktal satürasyon ölçümlerinin ortalama değerleri 96.46 ± 1.65 ve 95.99 ± 1.49 idi. Çalışmaya alınan bebeklerin 2247'si (% 99,38) taramadan geçti, 14'ü (% 0,61) geçemedi. Kritik konjenital kalp defektlerinde genel test yanlış pozitif oranı % 0.6 idi. Taramayı geçemeyenlerin hiçbirinde kritik konjenital kalp defekti görülmedi. Kritik konjenital kalp defektleri vakası saptanmadığından duyarlılık ve pozitif prediktif değer hesaplanamadı. Nabız oksimetre testinin özgüllüğü ve negatif prediktif değeri sırasıyla% 99.3 ve% 100 idi. Sonuç: Nabız oksimetreli taramanın özellikle ikinci basamak sağlık hizmeti sunan perifer bölgelerde yaygınlaştırılması gerektiğinin altını çiziyoruz. Kritik konjenital kalp defektlerinin nabız oksimetresi ile taranmasının ülkemizdeki ulusal tarama programına dahil edilmesi gerektiğine inanıyoruz.

Keywords

• Nabız oksimetri taraması,
• Konjenital kalp defektleri,
• Türkiye

Supporting Institution

yok

Project Number

Ethics Committee approval for this study was obtained from Necmettin Erbakan University with the Ethics Committee decision number of 2020/2333.

References

1. 1. Tennant PW, Pearce MS, Bythell M, Rankin J. 20-year survival of children born with congenital anomalies: a population-based study. Lancet. 2010;375:649–56.
2. 2. Frank LH, Bradshaw E, Beekman R, et al. Critical congenital heart disease screening using pulse-oximetry. J Pediatr 2013; 162: 445–453.
3. 3. Ailes EC, Gilboa SM, Honein MA, Oster ME. Estimated number of infants detected and missed by critical congenital heart defect screening. Pediatrics. 2015;135:1000–8.
4. 4. Bruno CJ, Havranek T. Screening for critical congenital heart disease in newborns. Adv Pediatr. 2015;62(1):211–26.
5. 5. Peterson C, Ailes E, Riehle-Colarusso T et al. Late detection of critical congenital heart disease among US infants: estimation of the potential impact of proposed universal screening using pulse-oximetry. JAMA Pediatr. 2014;168(4):361–70.
6. 6. de-Wahl Granelli A, Wennergren M, Sandberg K, et al. Impact of pulse-oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39, 821 newborns. BMJ 2009; 338: 3037.
7. 7. Hoffman JI. It is time for routine neonatal screening by pulse-oximetry. Neonatology 2011; 99: 1–9.
8. 8. Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128: 1259–1267.

9. 9. Ewer AK. Screening for critical congenital heart defects with pulse-oximetry: medical aspects. Am J Perinatol 2016; 33: 1062–1066.
10. 10. Thangaratinam S, Brown K, Zamora J, et al. Pulse-oximetry screening for critical congenital heart defects in asymptomatic newborn infants: a systematic review and metaanalysis. Lancet 2012; 379: 2459–2464.
11. 11. Zhao QM, Ma XJ, Ge XL, et al. Pulse-oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet 2014; 384: 747–754. Erratum in: Lancet. 2014; 384:746.
12. 12. Ewer AK, Middleton LJ, Furmston AT et al. Pulse-oximetry screening for congenital heart defect in newborn infants (PuseOx): A test accuracy study. Lancet 2011; 378(9793): 785-794.
13. 13. Walsh W. Evaluation of pulse-oximetry screening in middle tennessee cases for consideration before universal screening. J Perinatol 2011; 31(2): 125-129.
14. 14. Narayen IC, Blom NA, Ewer AK et al. Aspects of pulse-oximetry screening for critical congenital heart defects: when, how and why? Arch Dis Child Fetal Neonatal Ed. 2016;101:F162–7.
15. 15. Turska Kmiec´ A, Borszewska Kornacka MK, Błaz W, et al. Early screening for critical congenital heart defects in asymptomatic newborns in Mazovia province: experience of the POLKARD pulse-oximetry programme 2006–2008 in Poland. Kardiol Pol 2012; 70: 370–376.
16. 16. Ozalkaya E, Akdağ A, Sen I, et al. Early screening for critical congenital heart defects in asymptomatic newborns in Bursa province. J Matern Fetal Neonatal Med 2016; 29: 1105–1107.
17. 17. Dilli D, Doğan V, Özyurt BM et al. Should we start a nationwide screening program for critical congenital heart disease in Turkey? A pilot study on four centres with different altitudes. Cardiol Young. 2019 Apr;29(4):475-480.
18. 18. Hamilçıkan Ş, Can E. Critical congenital heart disease screening with a pulse oximetry in neonates. J Perinat Med. 2018 Feb 23;46(2):203-207.
19. 19. Valmari P. Should pulse-oximetry be used to screen for ongenital heart disease? Arch Dis Child Fetal Neonatal Ed. 2007;92:219-24.
20. 20. Ewer AK. Review of pulse-oximetry screening for critical congenital heart defects in newborn infants. Curr Opin Cardiol 2013;28:92-6.
21. 21. Diller CL, Kelleman MS, Kupke KG et al. A modified algorithm for critical congenital heart disease screening using pulse-oximetry. Pediatrics 2018 May; 141: pii: e20174065.
22. 22. Granelli A, Wennergren M, Sandberg K et al. Impact of Pulse-oximetry screening on the detection of duct dependent congenital heart disease: a swedish prospective screening study in 39 821 newborns. BMJ 2009; 338: a3037.
23. 23. Riede FT, Wörner C, Dahnert I et al. Effectiveness of neonatal pulse-oximetry screening for detection of critical congenital heart disease in daily clinical routine: results from a prospective multicenter study. Eur J Pediatr 2010; 169(8): 975-981.
24. 24. Banait N, Ward-Platt M, Abu-Harb M et al. Pulse oximetry screening for critical congenital heart disease: a comparative study of cohorts over 11 years. J Matern Fetal Neonatal Med. 2019 Jan 4:1-5.
25. 25. Aybar A, Özdemir R, Karakurt C et al. Critical Congenital Heart Diseases Screening Using Pulse Oximetry. Van Med Journal 2018;25(4): 466-471