Source:

Hu
XJ
,
Ma
XJ
,
Zhao
QM
, et al
.
Pulse oximetry and auscultation for congenital heart disease detection
.
Pediatrics
.
2017
;
140
(
4
):
e20171154
: doi:
https://doi.org/10.1542/peds.2017-1154

Investigators from the Children’s Hospital of Fudan University and Shanghai Key Laboratory of Birth Defects in China conducted a multicenter prospective observational study to assess the accuracy of adding cardiac auscultation to pulse oximetry (POX) screening in the detection of congenital heart disease (CHD). All asymptomatic neonates born at 1 of 15 participating hospitals received cardiac auscultation immediately followed by POX by the same clinician. A positive screen was defined as a grade II or greater murmur on auscultation or one of the following on POX screening: SpO2 <90% in either limb or SpO2 of <95% in either limb and/or >3% difference between limbs. All neonates with a positive screen received echocardiography within 24 hours. All neonates with a negative screen were followed up at 6 weeks of age to assess their clinical status and for the presence of CHD.

CHD was categorized as critical (defects causing death or needing intervention before 28 days of age), serious (defects need intervention before 1 year of age), significant (defects persisting >6 months of age but not classified as critical or serious), or non-significant (defects not physically appreciable and not persisting after 6 months of age). Major CHD was defined as all critical and serious CHD. The sensitivity and specificity of POX alone and POX plus cardiac auscultation for identifying critical and major CHD were calculated.

There were 167,190 neonates included in analysis. Of 2,047 positive screens (1.2%), 1,170 patients had CHD (0.7%), including 42 with critical CHD and 145 with serious CHD. Cardiac auscultation criteria, rather than POX criteria, were the reason for most positive screens (N=1,781). Of the 165,143 negative screens, 156 newborns had CHD at follow-up, including 2 critical CHD and 14 serious CHD. The overall sensitivity and specificity of POX plus cardiac auscultation was 95.5% (95% CI 84.9–98.7) and 98.8% (95% CI 98.8–98.9) for critical CHD and 92.1% (95% CI 87.6–95.1) and 98.9% (95% CI 98.8–98.9) for major CHD. The sensitivity and specificity of POX alone was 77.3% (95% CI 63.0–87.2) and 99.8% (95% CI 99.8–99.9) for critical CHD and 44.3% (95% CI 37.7–51.2) and 99.9% (95% CI 99.8–99.9) for major CHD. The sensitivity and specificity for cardiac auscultation alone for critical CHD were 75.0% (95% CI 60.65–85.4%) and 99.0% (95% CI 98.9%–99.0%), respectively, and for major CHD were 83.7% (95% CI 78.1%–88.2%) and 99.0% (99.0%–99.1%), respectively. Cardiac auscultation alone detected only 4 of 7 patients with transposition of the great arteries, and POX alone only 1 of 6 newborns with coarctation of the aorta.

The investigators conclude that POX plus cardiac auscultation is a more sensitive method for detecting critical and major CHD than POX alone.

Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of...

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