Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge

POLAR study group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives. Study design: Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90% or if 2 independent measures of pre- and postductal SpO2 were <95% and/or the pre-/postductal difference was >3%. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses. Results: The prenatal detection rate of CCHDs was 73%. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0% (95% CI 23.7-76.3) and specificity was 99.1% (95% CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61% (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2% (95% CI 56.0-81.4). Conclusion: Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6% of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.
Original languageEnglish
Pages (from-to)29-35.e1
JournalJournal of Pediatrics
Volume197
DOIs
Publication statusPublished - 2018

Cite this

@article{bd0b3afe6a6841bca273976582030b85,
title = "Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge",
abstract = "Objective: To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives. Study design: Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90{\%} or if 2 independent measures of pre- and postductal SpO2 were <95{\%} and/or the pre-/postductal difference was >3{\%}. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses. Results: The prenatal detection rate of CCHDs was 73{\%}. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0{\%} (95{\%} CI 23.7-76.3) and specificity was 99.1{\%} (95{\%} CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61{\%} (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2{\%} (95{\%} CI 56.0-81.4). Conclusion: Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6{\%} of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.",
author = "{POLAR study group} and Narayen, {Ilona C.} and Blom, {Nico A.} and {van Geloven}, Nan and Blankman, {Ellen I. M.} and {van den Broek}, {Annique J. M.} and Martijn Bruijn and Clur, {Sally-Ann B.} and {van den Dungen}, {Frank A.} and Havers, {Hester M.} and {van Laerhoven}, Henri{\"e}tte and Mir, {Shahryar E.} and Muller, {Moira A.} and Polak, {Odette M.} and Rammeloo, {Lukas A. J.} and Gracita Ramnath and {van der Schoor}, {Sophie R. D.} and {van Kaam}, {Anton H.} and {te Pas}, {Arjan B.} and {van den Akker}, {E. S. A.} and {van den Berg}, E. and {de Boer}, {M. A.} and S. Bouwmeester and {van Dorp}, {M. C.} and {de Graaf}, {I. M.} and Haak, {M. C.} and Hermsen, {B. B. J.} and P. Hummel and B. Kok and Medema, {T. J.} and M{\'e}relle, {M. E.} and Mooren, {G. C. A. H. C. N.} and W. Onland and Pernet, {P. J.} and {von Rosenstiel}, {I. A.} and N. Schrijver-Levie and S. Six and Williams, {J. M.} and {van den Akker}, {E. S. A.} and {van den Berg}, E. and {de Boer}, {M. A.} and S. Bouwmeester and {van Dorp}, {M. C.} and {de Graaf}, {I. M.} and Haak, {M. C.} and Hermsen, {B. B. J.} and P. Hummel and B. Kok and Medema, {T. J.} and M{\'e}relle, {M. E.} and Mooren, {G. C. A. H. C. N.}",
year = "2018",
doi = "10.1016/j.jpeds.2018.01.039",
language = "English",
volume = "197",
pages = "29--35.e1",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge. / POLAR study group.

In: Journal of Pediatrics, Vol. 197, 2018, p. 29-35.e1.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge

AU - POLAR study group

AU - Narayen, Ilona C.

AU - Blom, Nico A.

AU - van Geloven, Nan

AU - Blankman, Ellen I. M.

AU - van den Broek, Annique J. M.

AU - Bruijn, Martijn

AU - Clur, Sally-Ann B.

AU - van den Dungen, Frank A.

AU - Havers, Hester M.

AU - van Laerhoven, Henriëtte

AU - Mir, Shahryar E.

AU - Muller, Moira A.

AU - Polak, Odette M.

AU - Rammeloo, Lukas A. J.

AU - Ramnath, Gracita

AU - van der Schoor, Sophie R. D.

AU - van Kaam, Anton H.

AU - te Pas, Arjan B.

AU - van den Akker, E. S. A.

AU - van den Berg, E.

AU - de Boer, M. A.

AU - Bouwmeester, S.

AU - van Dorp, M. C.

AU - de Graaf, I. M.

AU - Haak, M. C.

AU - Hermsen, B. B. J.

AU - Hummel, P.

AU - Kok, B.

AU - Medema, T. J.

AU - Mérelle, M. E.

AU - Mooren, G. C. A. H. C. N.

AU - Onland, W.

AU - Pernet, P. J.

AU - von Rosenstiel, I. A.

AU - Schrijver-Levie, N.

AU - Six, S.

AU - Williams, J. M.

AU - van den Akker, E. S. A.

AU - van den Berg, E.

AU - de Boer, M. A.

AU - Bouwmeester, S.

AU - van Dorp, M. C.

AU - de Graaf, I. M.

AU - Haak, M. C.

AU - Hermsen, B. B. J.

AU - Hummel, P.

AU - Kok, B.

AU - Medema, T. J.

AU - Mérelle, M. E.

AU - Mooren, G. C. A. H. C. N.

PY - 2018

Y1 - 2018

N2 - Objective: To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives. Study design: Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90% or if 2 independent measures of pre- and postductal SpO2 were <95% and/or the pre-/postductal difference was >3%. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses. Results: The prenatal detection rate of CCHDs was 73%. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0% (95% CI 23.7-76.3) and specificity was 99.1% (95% CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61% (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2% (95% CI 56.0-81.4). Conclusion: Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6% of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.

AB - Objective: To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives. Study design: Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90% or if 2 independent measures of pre- and postductal SpO2 were <95% and/or the pre-/postductal difference was >3%. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses. Results: The prenatal detection rate of CCHDs was 73%. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0% (95% CI 23.7-76.3) and specificity was 99.1% (95% CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61% (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2% (95% CI 56.0-81.4). Conclusion: Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6% of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85044280326&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/29580679

U2 - 10.1016/j.jpeds.2018.01.039

DO - 10.1016/j.jpeds.2018.01.039

M3 - Article

VL - 197

SP - 29-35.e1

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -