ORIGINAL ARTICLE

Routine pulse oximetry in the asymptomatic newborn

S Richmond, G Reay, M Abu Harb

Neonatal Unit, Sunderland Royal Hospital, Sunderland, UK

Correspondence to:
Correspondence to:
Dr Richmond, Sunderland Royal Hospital, Sunderland SR4 7TP, UK;
sam.richmond{at}ncl.ac.uk

Objective: To assess the effect of routine measurement of postductal oxygen saturation as an adjunct to routine clinical examination in the asymptomatic newborn.

Design and setting: Prospective study in a district general hospital.

Patients: All 6166 infants inborn between 1 April 1999 and 31 March 2001.

Intervention: Oxygen saturation was measured over two minutes, after the age of 2 hours and before discharge, in one foot of all babies not admitted directly to the neonatal unit. Babies with fractional (as opposed to functional) oxygen saturation (SaO₂) below 95% were examined by the midwife. If this examination was abnormal or if normal but further measurements were below 95%, an echocardiogram was performed. All babies with cardiac malformations diagnosed by 1 year of age were identified from databases maintained at the regional cardiology referral unit and the regional congenital malformation survey.

Results: Measurements were made in 98% of eligible babies. A fractional SaO₂ less than 95% was found in 5% but persisted in only 1%. Structural cardiac malformations were found in 50 (8.1/1000), 26 of whom had isolated ventricular septal defects. Of the remaining 24 with other cardiac malformations, attention was first drawn to six by low SaO₂, and four more, first noticed for other reasons, also had low SaO₂. Low SaO₂ also first drew attention to 13 other babies ill for other reasons.

Conclusion: Newborn babies with important cardiac malformations are often asymptomatic initially and the yield from clinical examination is poor. Measuring postductal saturation routinely in newborn babies before discharge is easy and can alert staff to ill babies.

Keywords: screening; congenital heart disease; cardiac malformations; oxygen saturation

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Fantoms

Martin Ward Platt
Arch. Dis. Child. Fetal Neonatal Ed. 2002 87: F1. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Mahle, W. T., Newburger, J. W., Matherne, G. P., Smith, F. C., Hoke, T. R., Koppel, R., Gidding, S. S., Beekman, R. H. III, Grosse, S. D., on behalf of the American Heart Association Congen, (2009). Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement From the American Heart Association and American Academy of Pediatrics. Circulation 120: 447-458 [Abstract] [Full Text]  
• Mahle, W. T., Newburger, J. W., Matherne, G. P., Smith, F. C., Hoke, T. R., Koppel, R., Gidding, S. S., Beekman, R. H. III, Grosse, S. D., on behalf of the American Heart Association Congen, (2009). Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP. Pediatrics 124: 823-836 [Abstract] [Full Text]  
• de-Wahl Granelli, A., Wennergren, M., Sandberg, K., Mellander, M., Bejlum, C., Inganas, L., Eriksson, M., Segerdahl, N., Agren, A., Ekman-Joelsson, B.-M., Sunnegardh, J., Verdicchio, M., Ostman-Smith, I. (2009). Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns. BMJ 338: a3037-a3037 [Abstract] [Full Text]  
• Chang, R.-K. R., Gurvitz, M., Rodriguez, S. (2008). Missed Diagnosis of Critical Congenital Heart Disease. Arch Pediatr Adolesc Med 162: 969-974 [Abstract] [Full Text]  
• Sendelbach, D. M., Jackson, G. L., Lai, S. S., Fixler, D. E., Stehel, E. K., Engle, W. D. (2008). Pulse Oximetry Screening at 4 Hours of Age to Detect Critical Congenital Heart Defects. Pediatrics 122: e815-e820 [Abstract] [Full Text]  
• Schultz, A. H., Localio, A. R., Clark, B. J., Ravishankar, C., Videon, N., Kimmel, S. E. (2008). Epidemiologic Features of the Presentation of Critical Congenital Heart Disease: Implications for Screening. Pediatrics 121: 751-757 [Abstract] [Full Text]  
• Valmari, P. (2007). Should pulse oximetry be used to screen for congenital heart disease?. Arch. Dis. Child. Fetal Neonatal Ed. 92: F219-F224 [Abstract] [Full Text]  
• Thangaratinam, S., Daniels, J., Ewer, A. K, Zamora, J., Khan, K. S (2007). Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review. Arch. Dis. Child. Fetal Neonatal Ed. 92: F176-F180 [Abstract] [Full Text]  
• Liske, M. R., Greeley, C. S., Law, D. J., Reich, J. D., Morrow, W. R., Baldwin, H. S., Graham, T. P., Strauss, A. W., Kavanaugh-McHugh, A. L., Walsh, W. F. (2006). Report of the Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease. Pediatrics 118: e1250-e1256 [Abstract] [Full Text]  
• Patton, C, Hey, E (2006). How effectively can clinical examination pick up congenital heart disease at birth?. Arch. Dis. Child. Fetal Neonatal Ed. 91: F263-F267 [Abstract] [Full Text]  
• Pass, K. A. (2003). Not as Pink as You Think!. Pediatrics 111: 670-671 [Full Text]