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Pulse oximetry is highly specific and moderately sensitive for detecting critical congenital heart defects in asymptomatic newborn babies, according to a new meta-analysis. Does it meet criteria for universal screening?
Congenital heart defects are a major cause of infant death. Timely diagnosis allows for early treatment and improves outcomes. Pulse oximetry is a noninvasive method that can detect defects that might not be identified clinically, and it has been proposed as a screening test for clinical practice.
Researchers performed a systematic review of the literature and identified studies that evaluated the accuracy of pulse oximetry in the detection of critical congenital heart defects in asymptomatic newborns. Of 552 studies, 13 with data on 229,421 babies were included in the analysis. A critical congenital heart defect was defined as any potentially life-threatening, duct-dependent disorder from which infants die or undergo invasive procedures within 28 days of birth.
Overall, pulse oximetry had high specificity (99%) and moderate sensitivity (76%), with a low false-positive rate (0.14%). The false-positive rate was significantly lower when the test was performed more than 24 hours after birth than when it was done before 24 hours.
Inclusion of newborns in whom heart defects were suspected before birth did not affect the sensitivity of the test. Mothers given false-positive results were no more anxious than those who received true-negative results.
Last fall, US Secretary of Health and Human Services Kathleen Sebelius directed that screening for CCHDs be added to the uniform screening panel for newborns.
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