Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns
Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns
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DOI：
10.1542/peds.111.3.451
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发表时间：
2003-03-01
期刊：
影响因子：
8
通讯作者：
Bierman, FZ
中科院分区：
文献类型：
--
作者：
Koppel, RI;Druschel, CM;Bierman, FZ
目标。目的：确定脉搏血氧饱和度筛查危重先天性心血管畸形(CCVM)新生儿的敏感性、特异性、预测值和准确性。对2所医院婴幼儿托儿所的无症状新生儿进行脉搏血氧饱和度测定。对筛查阳性(24小时饱和度小于或等于95%)的婴儿进行心脏超声检查。收集和分析真阳性和假阳性以及阴性的数据。对11 281例无症状新生儿进行血氧饱和度测定，发现CCVM 3例(完全性肺静脉异位返流x2、动脉干)。在研究期间，胎儿超声心动图检测到的15例CCVM胎儿中有9例活产。6名患有CCVM的婴儿在筛查前已有症状。有1例假阳性筛查。两名筛查阴性的婴儿再次入院(缩窄，左肺动脉发育不良，伴主-肺侧支)。在数据库中搜索的其他心脏诊断是非紧急的，包括卵圆孔未闭、外周性肺狭窄和室间隔缺损。所有活产儿中临界CCVM的患病率为1/564，筛查人群中为1/2256(敏感度：60%；特异度：99.95%；阳性预测值：75%；阴性预测值：99.98%；准确率：99.97%)。这种筛查测试简单、非侵入性和廉价，可以与国家强制筛查一起实施。假阴性筛查的患者有血氧仪无法检测到的病变。该人群的敏感性、特异性和预测价值令人满意，表明筛查应应用于更大的人群，特别是在胎儿检测率较低导致无症状新生儿CCVM患病率增加的情况下。
Objective. To determine the sensitivity, specificity, predictive value, and accuracy of a program of pulse oximetry screening of asymptomatic newborns for critical congenital cardiovascular malformation (CCVM).Methods. Pulse oximetry was performed on asymptomatic newborns in the well-infant nurseries of 2 hospitals. Cardiac ultrasound was performed on infants with positive screens (saturation less than or equal to95% at >24 hours). Data regarding true and false positives as well as negatives were collected and analyzed.Results. Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases of CCVM were detected (total anomalous pulmonary venous return x2, truncus arteriosus). During the study interval, there were 9 live births of infants with CCVM from a group of 15 fetuses with CCVM detected by fetal echocardiography. Six infants with CCVM were symptomatic before screening. There was 1 false-positive screen. Two infants with negative screens were readmitted (coarctation, hypoplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were non-urgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of critical CCVM among all live births was 1 in 564 and among the screened population was 1 in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive value: 75%; negative predictive value: 99.98%; accuracy: 99.97%).Conclusions. This screening test is simple, non-invasive, and inexpensive and can be administered in conjunction with state-mandated screening. The false-negative screen patients had lesions not amenable to detection by oximetry. The sensitivity, specificity, and predictive value in this population are satisfactory, indicating that screening should be applied to larger populations, particularly where lower rates of fetal detection result in increased CCVM prevalence in asymptomatic newborns.