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Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

Published online by Cambridge University Press:  28 September 2020

Sruti Rao Open the ORCID record for Sruti Rao [Opens in a new window] ,
M. B. Goens ,
Orrin B. Myers  and
Emilie A. Sebesta
Sruti Rao*
Affiliation:
Division of Pediatric Cardiology, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
M. B. Goens
Affiliation:
Division of Pediatric Cardiology, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
Orrin B. Myers
Affiliation:
Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
Emilie A. Sebesta
Affiliation:
Department of Pediatrics, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
*
Author for correspondence: Sruti Rao, MD, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE19803, USA. E-mail: soodsr11@gmail.com
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Abstract

Aim:

To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time.

Methods:

We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time.

Results:

Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = −0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88–0.97) per month.

Conclusion:

This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.

Keywords

Pulse oximetry screeninghigh altitudefalse positivecritical congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1851 - 1855
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Mahle, WT, Newburger, JW, Matherne, GP, et al. 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 2009; 120: 447–458. doi: 10.1161/CIRCULATIONAHA.109.192576 CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Data and statistics on congenital heart defects. Available at: https://www.cdc.gov/ncbddd/heartdefects/data.html.Google Scholar
Plana, MN, Zamora, J, Suresh, G, Fernandez-Pineda, L, Thangaratinam, S, Ewer, AK. Pulse oximetry screening for critical congenital heart defects. Cochrane Database Syst Rev 2018; 3: CD011912. doi: 10.1002/14651858.CD011912.pub2 Google ScholarPubMed
Brown, KL, Ridout, DA, Hoskote, A, Verhulst, L, Ricci, M, Bull, C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 2006; 92: 1298–1302. http://heart.bmj.com/content/92/9/1298.abstract.CrossRefGoogle ScholarPubMed
Thangaratinam, S, Brown, K, Zamora, J, Khan, KS, Ewer, AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 2012; 379: 2459–2464. doi: 10.1016/S0140-6736(12)60107-X CrossRefGoogle ScholarPubMed
Kemper, AR, Mahle, WT, Martin, GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128: e1259–e1267. doi: 10.1542/peds.2011-1317 CrossRefGoogle ScholarPubMed
de-Wahl Granelli, A, Wennergren, M, Sandberg, K, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: A Swedish prospective screening study in 39,821 newborns. BMJ 2009; 338: a3037. doi: 10.1136/bmj.a3037 CrossRefGoogle ScholarPubMed
Ewer, AK, Martin, GR. Newborn pulse oximetry screening: which algorithm is best? Pediatrics 2016; 138: e20161206. doi: 10.1542/peds.2016-1206 CrossRefGoogle ScholarPubMed
Jegatheesan, P, Song, D, Angell, C, Devarajan, K, Govindaswami, B. Oxygen saturation nomogram in newborns screened for critical congenital heart disease. Pediatrics 2013; 131: e1803–e1810. doi: 10.1542/peds.2012-3320 CrossRefGoogle ScholarPubMed
Ravert, P, Detwiler, TL, Dickinson, JK. Mean oxygen saturation in well neonates at altitudes between 4498 and 8150 feet. Adv Neonatal Care 2011; 11: 412–417. doi: 10.1097/ANC.0b013e3182389348 CrossRefGoogle ScholarPubMed
Abouk, R, Grosse, SD, Ailes, EC, Oster, ME. Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths. JAMA 2017; 318: 2111–2118. http://dx.doi.org/10.1001/jama.2017.17627.CrossRefGoogle ScholarPubMed
Thilo, EH, Park-Moore, B, Berman, ER, Carson, BS. Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child 1991; 145: 1137–1140.10.1001/archpedi.1991.02160100069025CrossRefGoogle Scholar
González-Andrade, F, Echeverría, D, López, V, Arellano, M. Is pulse oximetry helpful for the early detection of critical congenital heart disease at high altitude? Congenit Heart Dis 2018; 13: 911–918. doi: 10.1111/chd.12654 CrossRefGoogle ScholarPubMed
Paranka, MS, Brown, JM, White, RD, Park, MV, Kelleher, AS, Clark, RH. The impact of altitude on screening for critical congenital heart disease. J Perinatol 2018; 38: 530–536. doi: 10.1038/s41372-018-0043-9 CrossRefGoogle ScholarPubMed
Wright, J, Kohn, M, Niermeyer, S, Rausch, CM. Feasibility of critical congenital heart disease newborn screening at moderate altitude. Pediatrics 2014; 133: e561–e569. doi: 10.1542/peds.2013-3284 CrossRefGoogle ScholarPubMed
Evers, PD, Vernon, MM, Schultz, AH. Critical congenital heart disease screening practices among licensed midwives in Washington State. J Midwifery Womens Health 2015; 60: 206–210. doi: 10.1111/jmwh.12274 CrossRefGoogle ScholarPubMed
Lueth, E, Russell, L, Wright, J, et al. A novel approach to critical congenital heart disease (CCHD) screening at moderate altitude. Int J Neonatal Screen 2016; 2: 4. doi: 10.3390/ijns2030004 CrossRefGoogle Scholar
Oster, ME, Aucott, SW, Glidewell, J, et al. Lessons learned from newborn screening for critical congenital heart defects. Pediatrics 2016; 137: e20154573. doi: 10.1542/peds.2015-4573 CrossRefGoogle ScholarPubMed
Jawin, V, Ang, HL, Omar, A, Thong, MK. Beyond critical congenital heart disease: newborn screening using pulse oximetry for neonatal sepsis and respiratory diseases in a middle-income country. PLoS One 2015; 10: e0137580. doi: 10.1371/journal.pone.0137580 CrossRefGoogle Scholar