Evaluation of Pulse Oximetry in the Early Diagnosis of Cardiac and NonCardiac Diseases in Healthy Newborns

Document Type: Original Article

Authors

1 Department of Neonatal Care Unit, Children’s Medical Center, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Pediatric Department, Tehran University of Medical Sciences, Tehran, Iran

3 Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Neonatal Care Unit, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Critical congenital heart diseases (CCHDs) are among the most common birth malformations. This study aimed to determine the cardiac and noncardiac diseases in the Iranian healthy newborns using pulse oximetry (POX) as a suggested screening method.
Methods: In this cross-sectional study, healthy term and near term neonates who were born from October 2017 to March 2018 were evaluated. Preductal and postductal POX was performed in all asymptomatic healthy newborns after 24 hours of life or at any time before discharge from the nursery. Oxygen saturation (SPO2) was considered normal if SPO2 was  95%, and the difference between preductal O2 saturation and postductal POX was obtained at ≤ 3%. The POX was repeated after 2 hours for abnormal patients. In the case of the same results in both repeated measures, echocardiography, chest X-ray, sepsis screening, and blood glucose were conducted.
Results: A total of 413 asymptomatic healthy term and near term neonates underwent the pulse oximetry screening (POX). The mean birth weight and gestational age of the neonates were 3256.31±509.62 gr and 38.2 weeks, respectively. The POX was performed averagely 19.5 hours after birth. Finally, a total of 10 cases were detected with abnormal POX. Among these 10 patients, three cases had cardiac diseases (i.e., transposition of the great arteries, ventricular septal defect/pulmonary atresia, and ventricular septal defect/pulmonary hypertension), three cases had noncardiac diseases (i.e., esophageal stenosis, hypoglycemia, and persistent pulmonary hypertension/sepsis), and four subjects were healthy.
Conclusion: The obtained findings showed that routine pox, along with clinical examinations could be applied, especially in developing countries for the early detection of cardiac and noncardiac diseases in asymptomatic newborns.

Keywords


1. Shahzad M, Waqar T, Waheed KAI, Gul R, Fatima ST. Pulse oximetry as a screening tool for critical congenital heart defects in newborns. J Pak Med Assoc. 2017; 67(8):1220-3.
2. 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.
3. Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet. 2012; 379(9835):2459-64.
4. Tsao PC, Shiau YS, Chiang SH, Ho HC, Liu YL, Chung YF, et al. Development of a newborn screening program for critical congenital heart disease (CCHD) in Taipei. PloS One. 2016; 11(4):e0153407.
5. Jawin V, Ang H-L, Omar A, Thong M-K. Beyond critical congenital heart disease: newborn screening using pulse oximetry for neonatal sepsis and respiratory diseases in a middle-income country. PloS oneOne. 2015; 10(9):e0137580
6. Narayen IC, Blom NA, van Geloven N, Blankman EI, van den Broek AJ, Bruijn M, et al. Accuracy of pulse oximetry screening for critical congenital heart defects after home birth and early postnatal
discharge. J Pediatr. 2018; 197:29-35.e1.
7. Narayen IC, Blom NA, Ewer AK, Vento M, Manzoni P, te Pas AB. Aspects of pulse oximetry screening for critical congenital heart defects: when, how and why? Arch Dis Child Fetal Neonatal Ed. 2015; 101(2):F162-7.
8. Ewer AK. Pulse oximetry screening for critical congenital heart defects in newborn infants: Should it be routine? Arch Dis Child Fetal Neonatal Ed. 2014; 99(1):F93-5.
9. Movahedian AH, Mosayebi Z, Sagheb S. Evaluation of pulse oximetry in the early detection of cyanotic congenital heart disease in newborns. J Tehran Univ Heart Center. 2016; 11(2):73.
10. Ismail AQT, Cawsey M, Ewer AK. Newborn pulse oximetry screening in practice. Arch Dis Child Educ Pract Ed. 2017; 102(3):155-61.
11. Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, et al. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation. 2009; 120(5):447-58.
12. Ewer AK, Martin GR. Newborn pulse oximetry screening: which algorithm is best? Pediatrics. 2016; 138(5):e20161206.
13. Johnson LC, Lieberman E, O’Leary E, Geggel RL. Prenatal and newborn screening for critical congenital heart disease: findings from a nursery. Pediatrics. 2014; 134(5):916-22.
14. Mosayebi Z, Movahedin AH, Safari A, Akbari H. Evaluation of the result of hand and foot pulse oximetry in the early detection of cyanotic congenital heart diseases in newborns delivered at Kashan Shabihkhani hospital during the first 6 months of 2006. Razi J Med Sci. 2012; 19(101):15-22.