Evaluating the diagnostic value of clinical examination in combination with dual-zone pulse oximetry for diagnosis of critical congenital heart diseases in newborns

Aim. To evaluate the diagnostic significance of clinical examination in combination with pulse oximetry for diagnosis of critical congenital heart disease in newborns in the early neonatal period.

Methods. A retrospective analysis of the screening results for dual-zone pulse oximetry in combination with clinical examination in 4201 newborns (2211 girls and 1990 boys) was performed for the period from June 2013 to December 2014. Criteria of inclusion were: healthy full-term neonates (94%) and preterm infants with a gestational age of >34-35 weeks (6%); no signs of diseases that require intensive care at birth; performed pulse oximetry. Results of physical examination, SpO2, echocardiography were examined in newborns with positive test. Diagnostic value of the method for detecting the critical congenital heart defects was evaluated in terms of sensitivity and specificity.

Results. In the structure of congenital diseases of the circulatory system, diagnosed in the neonatal period, congenital heart defects, mainly with ductus-dependent hemodynamics, contributed to 19%. The efficiency of critical congenital heart defects timely diagnosis is increasing recently due to prenatal detection (62.5% of cases) and diagnosis in the early neonatal period (87.5% of cases). Screening with dual-zone pulse oximetry performed at 24-48 hours after birth has facilitated the postnatal diagnosis. Positive results of dual-zone pulse oximetry were registered in 10 infants (0.24% of the total number of examined newborns). In 8 cases, echocardiography verified critical congenital heart defects; false-positive test was seen in 2 cases, false-negative test - in 1 case.

Conclusion. The specificity of pulse oximetry for diagnosis of severe congenital heart defects in the early neonatal period is very high (99.9 %), the sensitivity is 87.5%, with a small probability of false positives, that allows to consider the dual-zone pulse oximetry as a useful diagnostic method complementary to a thorough clinical examination of the newborn.