Pulse oximetry test for screening congenital heart diseases: a systematic review

Saganski, Gabrielle Freitas; Freire, Márcia Helena de Souza; Santos, Wendel Mombaque dos

doi:10.1590/1980-220X-REEUSP-2023-0215en

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0215en copy

Pulse oximetry test for screening congenital heart diseases: a systematic review

Prueba de oximetría de pulso para el screening de cardiopatías congénitas: revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To determine the accuracy of the Pulse Oximetry Test (POT) in screening for Congenital Heart Diseases (CHD) in newborns in the first 48 hours of life.

Method:

Systematic review of diagnostic test accuracy with meta-analysis. The selection of studies was carried out in June 2021. Studies were selected with newborns, in a hospital or home environment, without a previous diagnosis of CHD, regardless of gestational age at birth, who underwent POT within the first 48 hours after birth. Registration on the PROSPERO platform – CRD42021256286.

Results:

Twenty-nine studies were included, totaling a population of 388,491 newborns. POT demonstrated sensitivity of 47% (95% CI: 43% to 50%) and specificity of 98% (95% CI: 98% to 98%). Subgroup analyses were carried out according to the different testing period, inclusion of retests in protocols and population of premature newborns.

Conclusion:

POT is a test with moderate sensitivity and high specificity. It is more effective when carried out within 24h – 48h of birth; in protocols that present retests, within two hours after the first measurement. It does not show satisfactory effectiveness for premature newborns.

DESCRIPTORS
Oximetry; Infant, Newborn; Heart Defects, Congenital; Pediatrics; Systematic Review

Author and year	N	PRT	Oxygen saturation cut-off point and care procedures
Almawazini et al.(²⁰20. Almawazini AM, Hanafi HK, Madkhali HA, Majrashi NB. Effectiveness of the critical congenital heart disease screening program for early diagnosis of cardiac abnormalities in newborn infants. Saudi Med J. 2017;38(10):1019–24. doi: http://dx.doi.org/10.15537/smj.2017.10.20295. PubMed PMID: 28917066. https://doi.org/10.15537/smj.2017.10.202... )	2,961	21 to < 40	≥95%: no additional procedures. 90–94%: new assessment in 1 hour. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Andrews et al.(²¹21. Andrews JP, Ross AS, Salazar MA, Tracy NA, Burke Jr BL. Smooth implementation of critical congenital heart defect screening in a newborn nursery. Clin Pediatr. 2014;53(2):173–6. doi: http://dx.doi.org/10.1177/0009922813502850. PubMed PMID: 24037922. https://doi.org/10.1177/0009922813502850... )	1,908	24 to 48	≥95%: no additional procedures. <95%: three new assessments in 1, 2 and 3 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Arlettaz et al.(²²22. Arlettaz R, Bauschatz AS, Monkhoff M, Essers B, Bauersfeld U. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr. 2006;165(2):94–8. doi: http://dx.doi.org/10.1007/s00431-005-0006-y. PubMed PMID: 16211399. https://doi.org/10.1007/s00431-005-0006-... )	3,257	6 to 12	≥95%: no additional procedures. 90–94%: new assessment in 6 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Van Naarden Braun et al.(²³23. Van Naarden Braun K, Grazel R, Koppel R, Lakshminrusimha S, Lohr J, Kumar P, et al. Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit. J Perinatol. 2017;37(10):1117–23. doi: http://dx.doi.org/10.1038/jp.2017.105. PubMed PMID: 28749481. https://doi.org/10.1038/jp.2017.105... )	3,423	24 to 48	≥95%: no additional procedures. <95%: two new assessments in 1 and 2 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: Echocardiogram was performed.
Cubells et al.(²⁴24. Cubells E, Torres B, Nuñez-Ramiro A, Sánchez-Luna M, Izquierdo I, Vento M. Congenital critical heart defect screening in a health area of the community of Valencia (Spain): a prospective observational study. Int J Neonatal Screen. 2018;4(1):3. doi: http://dx.doi.org/10.3390/ijns4010003. PubMed PMID: 33072929. https://doi.org/10.3390/ijns4010003... )	8,856	24 to 48	≥95%: no additional procedures. 90–95%: new assessment in one hour. If lower than 94% persisted, an echocardiogram was performed. <90%: admission to the NICU and echocardiogram.
Diller et al.(²⁵25. Diller CL, Kelleman MS, Kupke KG, Quary SC, Kochilas LK, Oster ME. A modified algorithm for critical congenital heart disease screening using pulse oximetry. Pediatrics. 2018;141(5):1–7. doi: http://dx.doi.org/10.1542/peds.2017-4065. PubMed PMID: 29691284. https://doi.org/10.1542/peds.2017-4065... )	77,154	up to 24	≥95%: no additional procedures. 90–94%: new assessment between 1 and 2 hours. If lower than 94% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Donia and Tolba(²⁶26. Donia AES, Tolba OA. Use of early pulse oximetry in the detection of cardiac lesions among asymptomatic term newborns. Gaz Egypt Paediatr Assoc. 2016;64(1):1–5. doi: http://dx.doi.org/10.1016/j.epag.2016.02.001. https://doi.org/10.1016/j.epag.2016.02.0... )	120	2 to 24	≥95%: no additional procedures. <95%: new assessment in 2 hours. If lower than 95% persisted, an echocardiogram was performed.
Gamhewage et al.(²⁷27. Gamhewage NC, Perera KSY, Weerasekera M. Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka. Sri Lanka J Child Health. 2021;50(4):699–703. doi: http://dx.doi.org/10.4038/sljch.v50i4.9890. https://doi.org/10.4038/sljch.v50i4.9890... )	8,718	24 to 48	≥95%: no additional procedures. <95%: echocardiogram performed.
Gong et al.(²⁸28. Gong A, Livingston J, Creel L, Ocampo E, McKee-Garrett T, Guillory C. Texas Pulse Oximetry Project: a multicenter educational and quality improvement project for implementation of critical congenital heart disease screening using pulse oximetry. Am J Perinatol. 2017;34(9):856–60. doi: http://dx.doi.org/10.1055/s-0037-1599214. PubMed PMID: 28264208. https://doi.org/10.1055/s-0037-1599214... )	11,322	24 to 48	≥95%: no additional procedures. 90–94%: new assessment between 1 and 2 hours. If lower than 94% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Havelund et al.(²⁹29. Havelund KW, Hulgaard M, Malberg D, Fenger-Gron J. Implementation of pulse oximetry screening in a Danish maternity ward. Dan Med J. 2019;66(11):1–4. PubMed PMID: 31686645.)	2,796	up to 24	≥95%: no additional procedures. <95%: two new assessments in 30 minutes and 1 hour. Pediatric evaluation and echocardiogram persisting below 95%.
Jones et al.(³⁰30. Jones AJ, Howarth C, Nicholl R, Mat-Ali E, Knowles R. The impact and efficacy of routine pulse oximetry screening for CHD in a local hospital. Cardiol Young. 2016;26(7):1397–405. doi: http://dx.doi.org/10.1017/S1047951115002784. PubMed PMID: 26905447. https://doi.org/10.1017/S104795111500278... )	10,260	2 to 24	≥95%: no additional procedures. <95%: new assessment in 2 hours. If lower than 95% persisted, admission to the NICU and an echocardiogram was performed. <90%: admission to the NICU and echocardiogram.
Kardasevic et al.(³¹31. Kardasevic M, Jovanovic I, Samardzic JP. Implementation of congenital heart diseases screening at the Bihac Cantonal Hospital. Mater Sociomed. 2017;29(1):45–7. doi: http://dx.doi.org/10.5455/msm.2017.29.45-47. PubMed PMID: 28484354. https://doi.org/10.5455/msm.2017.29.45-4... )	1,745	24 to 48	≥95%: no additional procedures. <95%: new assessment in 1 and 2 hours. If lower than 95% persisted, an echocardiogram was performed. <90% echocardiogram performed.
Manja et al.(³²32. Manja V, Mathew B, Carrion V, Lakshminrusimha S. Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit. J Perinatol. 2015;35(1):67–71. doi: http://dx.doi.org/10.1038/jp.2014.135. PubMed PMID: 25058746. https://doi.org/10.1038/jp.2014.135... )	1,445	24 to 48	≥95%: no additional procedures. <95%: new assessment in 1 and 2 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Meberg et al.(³³33. Meberg A, Andreassen A, Brunvand L, Markestad T, Moster D, Nietsch L, et al. Pulse oximetry screening as a complementary strategy to detect critical congenital heart defects. Acta Paediatr. 2009;98(4):682–6. doi: http://dx.doi.org/10.1111/j.1651-2227.2008.01199.x. PubMed PMID: 19154526. https://doi.org/10.1111/j.1651-2227.2008... )	48,686	up to 21	≥95%: no additional procedures. <95%: clinical examination or echocardiogram.
Meberg et al.(³⁴34. Meberg A, Brügmann-Pieper S, Due Jr R, Eskedal L, Fagerli I, Farstad T, et al. First day of life pulse oximetry screening to detect congenital heart defects. J Pediatr. 2008;152(6):761–5. doi: http://dx.doi.org/10.1016/j.jpeds.2007.12.043. PubMed PMID: 18492511. https://doi.org/10.1016/j.jpeds.2007.12.... )	57,909	24 to 48	≥95%: no additional procedures. <95% were symptomatic and referred for evaluation by a pediatrician. Asymptomatic patient re-evaluated within 3 hours and persisting <95% the pediatrician was called.
Miller et al.(³⁵35. Miller K, Vig K, Goetz E, Spicer G, Yang AJ, Hokanson JS. Pulse oximetry screening for critical congenital heart disease in planned out of hospital births and the incidence of critical congenital heart disease in the Plain community. J Perinatol. 2016;36(12):1088–91. doi: http://dx.doi.org/10.1038/jp.2016.135. PubMed PMID: 27583398. https://doi.org/10.1038/jp.2016.135... )	1,600	24 to 48	≥95%: no additional procedures. <95%: new assessment in 1 and 2 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Mohsin et al.(³⁶36. Mohsin M, Humayun KN, Atiq M. Clinical screening for congenital heart disease in newborns at a tertiary care hospital of a developing country. Cureus. 2019;11(6):e4808. doi: http://dx.doi.org/10.7759/cureus.4808. PubMed PMID: 31403007. https://doi.org/10.7759/cureus.4808... )	1,650	24 to 48	≥95%: no additional procedures. ≤94%: new evaluation in one hour. If lower than 94% persisted, an echocardiogram was performed.
Mosayebi et al.(³⁷37. Mosayebi Z, Movahedian AH, Amini E, Asbagh PA, Ghorbansabagh V, Shariat M, et al. Evaluation of pulse oximetry in the early diagnosis of cardiac and noncardiac diseases in healthy newborns. Iran. J. Neonatol. 2020;11:43–50. doi: http://dx.doi.org/10.22038/IJN.2019.38511.1608. https://doi.org/10.22038/IJN.2019.38511.... )	413	24 to 48	≥95%: no additional procedures. <95%: new assessment in up to 2 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Özalkaya et al.(³⁸38. Özalkaya E, Akdagˇ A, S¸en I, Cömert E, Yaren HM. Early screening for critical congenital heart defects in asymptomatic newborns in Bursa province. J Matern Fetal Neonatal Med. 2016;29(7):1105–7. doi: http://dx.doi.org/10.3109/14767058.2015.1035642. PubMed PMID: 25902399. https://doi.org/10.3109/14767058.2015.10... )	8,208	24 to 48	≥95%: no additional procedures. <95%: echocardiogram performed.
Patriciu et al.(³⁹39. Patriciu M, Avasiloaiei A, Moscalu M, Stamatin M. Pulse oximetry during the first 24 hours as a screening tool for congenital heart defects. J Crit Care Med. 2017;3(1):12–7. doi: http://dx.doi.org/10.1515/jccm-2017-0004. PubMed PMID: 29967865. https://doi.org/10.1515/jccm-2017-0004... )	5,406	up to 24	≥95%: no additional procedures. <95%: echocardiogram performed.
Prudhoe et al.(⁴⁰40. Prudhoe S, Abu-Harb M, Richmond S, Wren C. Neonatal screening for critical cardiovascular anomalies using pulse oximetry. Arch Dis Child Fetal Neonatal Ed. 2013;98(4):F346–50. doi: http://dx.doi.org/10.1136/archdischild-2012-302045. PubMed PMID: 23341250. https://doi.org/10.1136/archdischild-201... )	29,930	2 to 48	≥95%: no additional procedures. <95%: echocardiogram performed.
Richmond et al.(⁴¹41. Richmond S, Reay G, Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed. 2002;87(2):83–8. doi: http://dx.doi.org/10.1136/fn.87.2.F83. PubMed PMID: 12193511. https://doi.org/10.1136/fn.87.2.F83... )	5,626	24 to 48	≥95%: no additional procedures. <95%: new assessment in up to 2 hours. If lower than 95% persisted, an echocardiogram was performed.
Saxena et al.(⁴²42. Saxena A, Mehta A, Ramakrishnan S, Sharma M, Salhan S, Kalaivani M, et al. Pulse oximetry as a screening tool for detecting major congenital heart defects in Indian newborns. Arch Dis Child Fetal Neonatal Ed. 2015;100(5):F416-21. doi: http://dx.doi.org/10.1136/archdischild-2014-307485. PubMed PMID: 26038347. https://doi.org/10.1136/archdischild-201... )	19,009	up to 48	≥95%: no additional procedures. <95%: echocardiogram performed.
Singh et al.(⁴³43. Singh A, Rasiah SV, Ewer AK. The impact of routine predischarge pulse oximetry screening in a regional neonatal unit. Arch Dis Child Fetal Neonatal Ed. 2014;99(4):F297–302. doi: http://dx.doi.org/10.1136/archdischild-2013-305657. PubMed PMID: 24646619. https://doi.org/10.1136/archdischild-201... )	25,859	up to 12	≥95%: no additional procedures. <95%: new assessment in up to 2 hours. If lower than 95% persisted, admission to the NICU and an echocardiogram was performed.
Tautz et al.(⁴⁴44. Tautz J, Merkel C, Loersch F, Egen O, Hägele F, Thon HM, et al. Implication of pulse oxymetry screening for detection of congenital heart defects. Klin Padiatr. 2010;222(5):291–5. doi: http://dx.doi.org/10.1055/s-0030-1253391. PubMed PMID: 20458668. https://doi.org/10.1055/s-0030-1253391... )	3,336	6 to 36	≥95%: no additional procedures. 90–94%: new assessment in 4 and 6 hours. If lower than 95% persisted, an echocardiogram was performed. <90%: echocardiogram performed.
Tsao et al.(⁴⁵45. 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. doi: http://dx.doi.org/10.1371/journal.pone.0153407. PubMed PMID: 27073996. https://doi.org/10.1371/journal.pone.015... )	6,296	24 to 36	≥95%: no additional procedures. <95%: three new reviews in 30 minutes, 1 hour and 1 hour and 30 minutes. Persisting below 95% echocardiogram performance.
Vaidyanathan et al.(⁴⁶46. Vaidyanathan B, Sathish G, Mohanan ST, Sundaram KR, Warrier KK, Kumar RK. Clinical screening for Congenital heart disease at birth: a prospective study in a community hospital in Kerala. Indian Pediatr. 2011;48(1):25–30. doi: http://dx.doi.org/10.1007/s13312-011-0021-1. PubMed PMID: 20972295. https://doi.org/10.1007/s13312-011-0021-... )	5,487	up to 48	≥95%: no additional procedures. ≤94%: echocardiogram performed.
Walsh(⁴⁷47. Walsh W. Evaluation of pulse oximetry screening in Middle Tennessee: cases for consideration before universal screening. J Perinatol. 2011;31(2):125–9. doi: http://dx.doi.org/10.1038/jp.2010.70. PubMed PMID: 20508595. https://doi.org/10.1038/jp.2010.70... )	14,564	24 to 48	≥94%: no additional procedures. <94%: assessment by a pediatric cardiologist.
Zayachnikova et al.(⁴⁸48. Zayachnikova T, Delryu N, Shishimorov I, Magnitskaya O, Belan E. Accuracy of pulse oximetryfor early detection of critical congenital heart disease in Volgograd region (Russia). Archive Euromedica. 2020;10(2):53–4. doi: http://dx.doi.org/10.35630/2199-885X/2020/10/2.16. https://doi.org/10.35630/2199-885X/2020/... )	20,547	24 to 48	≥95%: no additional procedures. <95%: echocardiogram performed.

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Gabrielle Freitas Saganski Av. Prefeito Lothário Meissner, 623, Jardim Botânico, 80210-170 – Curitiba, PR, Brazil gabisaga@gmail.com