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Pulse Oximetry Detects Congenital Heart Disease In Newborns, Should Be Included In Routine Care

An article published online first in The Lancet reveals that a quick, non-invasive test measuring blood oxygen levels in newborns can detect a larger number of cases of life-threatening congenital heart defects 

than current standard approaches and should be included into the routine assessment of all newborns prior to their discharge from hospital. 

One of the highest causes of infant deaths in the developed world is congenital heart defects. Mid-trimester ultrasound scans and routine physical examinations shortly after birth, fail to identify many life threatening heart abnormalities with current screening techniques. Resulting in considerable number of babies going undiagnosed after leaving the hospital, which can lead to increased rates of complications or even death. Previous studies, although most earlier investigations were small and underpowered to estimate accuracy, reported the potential of pulse oximetry screening for identifying significant or life-threatening congenital heart defects in newborns. 

In the UK's largest pulse oximetry test accuracy study to date, Andrew Ewer and colleagues from the University of Birmingham and Birmingham Women's Hospital, UK, prospectively evaluated the ability of the test to identify critical congenital heart disease (causing death or requiring intrusive intervention before 28 days) or major congenital heart disease (causing death or requiring intrusive intervention before 12 months of age). 

Between February 2008 and January 2009, across six maternity units around the UK, over 20,000 apparently healthy newborn babies were screened with pulse oximetry before discharge from hospital and followed up to 12 months of age. 

The researchers discovered that pulse oximetry detected 75% of critical cases and 49% of all major congenital heart defects. After not including 35 cases of suspected congenital heart defects following antenatal ultrasound, the detection rate of pulse oximetry was 58% for critical cases and 28% for all major cases. 

The detection of critical congenital heart defects improved to 92%, and no babies died from undiagnosed heart disease, when pulse oximetry was combined with routine ultrasound and newborn physical examination. 

In 169 babies, pulse oximetry had a false positive rate of 0.8%. Six of these babies however, had significant heart defects, and an additional 40 babies had further problems (respiratory disorders and infections) that required urgent medical intervention. 

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