Evaluation of pulse oximetry screening in Middle Tennessee: cases for consideration before universal screening
Evaluation of pulse oximetry screening in Middle Tennessee: cases for consideration before universal screening
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DOI：
10.1038/jp.2010.70
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发表时间：
2011-02-01
影响因子：
2.9
通讯作者：
Walsh, W.
中科院分区：
文献类型：
--
作者：
Walsh, W.
目的：建议对无症状新生儿进行脉搏血氧仪筛查作为及时发现无症状新生儿危重先天性心脏病（CHD）的挽救生命的程序。我们评估了这种筛查并报告了在非研究环境中证明筛查问题的案例。 研究设计：在田纳西州中部评估了一项选择性的国家指导的公共卫生筛查计划； 14 564 名婴儿在出生 24 小时后和出院前接受了筛查。筛查是由当地医院的护士在非研究环境中进行的。对田纳西州中部的诊断方法和时间进行的平行调查显示，产前诊断的发生率高得惊人（66%）。 结果：以 94% 的饱和度值作为定义的正常值，阳性预测值小于 1%，其中 112 名婴儿出现假阳性病例，1 名婴儿出现真阳性病例（发生率 1/34 775）。唯一一个真正的阳性病例没有被转介进行评估。一个假阳性病例导致了昂贵的转诊和住院治疗。在为期一年的评估中，产前诊断与体格检查相结合，发现 44 名婴儿中有 43 名患有危重先心病。结论：在实施全民筛查之前，必须制定护理系统来解决本报告提出的教育和转诊问题。围产期杂志 (2011) 31, 125-129; doi：10.1038/jp.2010.70； 2010 年 5 月 27 日在线发布
Objective: Pulse oximetry screening of asymptomatic newborns is suggested as a life-saving procedure for the timely detection of critical congenital heart disease (CHD) in asymptomatic newborns. We evaluated this screening and report cases that demonstrate problems with screening in a non-research setting.Study Design: An elective state-directed public health screening program was evaluated in Middle Tennessee; 14 564 infants were screened after 24 h of age and before discharge. The screening was performed in a non-research setting by nurses at the local hospitals. A parallel investigation of the methods and timing of diagnosis in Middle Tennessee revealed a surprisingly high incidence of antenatal diagnosis (66%).Result: Using a saturation value of 94% as the defined normal, the positive predictive value was less than 1%, with 112 infants having a false positive case and 1 having a true positive case identified (incidence 1/34 775). The one true positive case was not referred for evaluation. One false-positive case resulted in a costly referral and hospitalization. Antenatal diagnosis when combined with physical examination detected 43 of 44 infants with critical CHD during the year-long evaluation.Conclusion: Before universal screening can be implemented, a system of care must be defined to address the educational and referral issues raised by this report. Journal of Perinatology (2011) 31, 125-129; doi:10.1038/jp.2010.70; published online 27 May 2010