95% at
>24 hours). Data regarding true and false positives as well as
negatives were collected and analyzed. NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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Screening for
Cardiac Anomalies
Objective.
To determine the sensitivity, specificity, predictive value, and
accuracy of a program of pulse oximetry screening of asymptomatic
newborns for critical congenital cardiovascular malformation (CCVM).
Methods.
Pulse oximetry was performed on asymptomatic newborns in the
well-infant nurseries of 2 hospitals. Cardiac ultrasound was
performed on infants with positive screens (saturation
95% at
>24 hours). Data regarding true and false positives as well as
negatives were collected and analyzed.
Results.
Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases
of CCVM were detected (total anomalous pulmonary venous return x2,
truncus arteriosus). During the study interval, there were 9 live
births of infants with CCVM from a group of 15 fetuses with CCVM
detected by fetal echocardiography. Six infants with CCVM were
symptomatic before screening. There was 1 false-positive screen. Two
infants with negative screens were readmitted (coarctation,
hypoplastic left pulmonary artery with aorto-pulmonary collaterals).
Other cardiac diagnoses in the database search were non-urgent,
including cases of patent foramen ovale, peripheral pulmonic stenosis,
and ventricular septal defect. The prevalence of critical CCVM among
all live births was 1 in 564 and among the screened population was 1
in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive
value: 75%; negative predictive value: 99.98%; accuracy: 99.97%).
Conclusions.
This screening test is simple, noninvasive, and inexpensive and can
be administered in conjunction with state-mandated screening. The
false-negative screen patients had lesions not amenable to detection
by oximetry. The sensitivity, specificity, and predictive value in
this population are satisfactory, indicating that screening should be
applied to larger populations, particularly where lower rates of
fetal detection result in increased CCVM prevalence in asymptomatic
newborns.
Date: 14 Mar 2003
Time: 08:41:57
This is a no brainer. We should use this to screen all newborns and make it a
part as our association's official endorsement/recommendation.
UserName: D. L. Caangay
Institution: Lee Memorial Hospital, Fort Myers
email: dlcaangay@pol.net
Date: 21 Mar 2003
Time: 08:42:46
Ideally, routine screening sounds fine. However I don't know how practical it
is. We do mother/baby. Babies would have to be in the nursery for some period of
time to have the oximetry done. The nursery would have to be staffed
accordingly. ECHO techs would have to be more available, and most importantly,
cardiologists would have to be available to read the ECHOs. This adds expense
and potentially lengthens stays if it doesn't all come together.
UserName: Mitchell Stern
Institution: Plantation General Hospital
telephone: 954-797-6460
email: neomd@aol.com
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