Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

K Van Naarden Braun; R Grazel; R Koppel; S Lakshminrusimha; J Lohr; P Kumar; B Govindaswami; M Giuliano; M Cohen; N Spillane; P Jegatheesan; D McClure; D Hassinger; O Fofah; S Chandra; D Allen; R Axelrod; J Blau; S Hudome; E Assing; L F Garg

doi:10.1038/jp.2017.105

Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

J Perinatol. 2017 Oct;37(10):1117-1123. doi: 10.1038/jp.2017.105. Epub 2017 Jul 27.

Authors

K Van Naarden Braun^{1

2}, R Grazel^{2

3}, R Koppel⁴, S Lakshminrusimha⁵, J Lohr⁶, P Kumar⁷, B Govindaswami⁸, M Giuliano⁹, M Cohen¹⁰, N Spillane⁹, P Jegatheesan⁸, D McClure¹¹, D Hassinger¹², O Fofah¹³, S Chandra¹⁴, D Allen¹⁴, R Axelrod¹⁵, J Blau¹⁶, S Hudome¹⁷, E Assing¹⁸, L F Garg²

Affiliations

¹ National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
² New Jersey Department of Health, Trenton, NJ, USA.
³ New Jersey Chapter, American Academy of Pediatrics, East Windsor, NJ, USA.
⁴ Long Island Jewish Cohen Children's Medical Center, New Hyde Park, NY, USA.
⁵ University of Buffalo Medical Center, Buffalo, NY, USA.
⁶ University of Minnesota Medical System, Minneapolis, MN, USA.
⁷ University of Illinois Medical Center, Peoria, IL, USA.
⁸ Santa Clara Valley Medical Center, San Jose, CA, USA.
⁹ Hackensack University Medical Center, Hackensack, NJ, USA.
¹⁰ Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, USA.
¹¹ Saint Joseph's Regional Medical Center, Paterson, NJ, USA.
¹² Morristown Medical Center, Morristown, NJ, USA.
¹³ Rutgers New Jersey Medical School, Newark, NJ, USA.
¹⁴ Saint Peter's University Hospital, New Brunswick, NJ, USA.
¹⁵ Capital Health Medical Center Hopewell, Pennington, NJ, USA.
¹⁶ Northwell Staten Island University Hospital, Staten Island, NY, USA.
¹⁷ Monmouth Medical Center, Long Branch, NJ, USA.
¹⁸ Jersey Shore University Medical Center, Neptune, NJ, USA.

Abstract

Objective: To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening.

Study design: Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants).

Results: Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%).

Conclusion: Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.

Publication types

Evaluation Study
Multicenter Study

MeSH terms

Echocardiography
Gestational Age
Heart Defects, Congenital / diagnosis*
Heart Defects, Congenital / epidemiology
Heart Defects, Congenital / therapy
Humans
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Neonatal Screening / methods*
Oximetry*
Oxygen Inhalation Therapy
Prospective Studies