Document Detail


Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP.
MedLine Citation:
PMID:  19581259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). METHODS AND RESULTS: A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. CONCLUSIONS: Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.
Authors:
William T Mahle; Jane W Newburger; G Paul Matherne; Frank C Smith; Tracey R Hoke; Robert Koppel; Samuel S Gidding; Robert H Beekman; Scott D Grosse; ; ;
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Publication Detail:
Type:  Journal Article     Date:  2009-07-06
Journal Detail:
Title:  Pediatrics     Volume:  124     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-04     Completed Date:  2009-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  823-36     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
American Heart Association*
Cross-Sectional Studies
Evidence-Based Medicine
Health Policy*
Heart Defects, Congenital / diagnosis*,  mortality
Humans
Infant, Newborn
Neonatal Screening
Oximetry*
Pediatrics*
Sensitivity and Specificity
Societies, Medical*
Survival Rate
Ultrasonography, Prenatal
United States
Investigator
Investigator/Affiliation:
W T Mahle / ; J W Newburger / ; G P Matherne / ; F C Smith / ; T R Hoke / ; R Koppel / ; S S Gidding / ; R H Beekman / ; S D Grosse /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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