Effectiveness of pulse-oximetry in addition to routine neonatal examination in detection of congenital heart disease in asymptomatic newborns

Objective: To assess the feasibility and effectiveness of pulse-oximetry as a screening tool in the detection of critical congenital heart disease (CCHD) in newborns. Methods: Post-natal babies born between 01/01/2007-31/12/2009 were eligible. Post-ductal pulse-oximetry was performed using Nellcor (R) NPB 40 pulse oximeter with reusable OXI-A/N saturation probe. Saturations >= 95% were deemed normal. If saturations were 595%, an echocardiogram was done. The regional paediatric cardiology database and death records identified babies later diagnosed with CCHD. Results: 6329/9613 eligible babies were studied and pulse-oximetry was performed at a mean age of 28 hours (range 6-72 hours). Fourteen babies had saturations 595%. CCHD was diagnosed in 7/14 babies; 4/7 had no clinical signs. Of the remaining 7 babies, 3 had non-critical but significant CHD and 4 had an undiagnosed respiratory illness or sepsis. All babies with low saturations had identifiable pathologies. One baby with normal saturations was later diagnosed with transposition of the great arteries. The sensitivity and specificity of identifying an unwell baby was 93.3% and 100% respectively; the sensitivity and specificity of identifying CCHD was 87.5% and 99.8% respectively. Clinical examination alone would have missed 4/7 (57%) of these. Conclusion: Pulse-oximetry is safe, acceptable, non-invasive and effective. Our study supports the routine use of pulse oximetry as part of the newborn check.