Pulsoxymetriescreening kann die diagnostische Lücke bei kritischen angeborenen Herzfehlern verkleinern : Erste Ergebnisse einer prospektiven multizentrischen Feldstudie in Sachsen (Originalien)

IntroductionNeonates with critical congenital heart disease (cCHD) may be free of symptoms for a short period after birth, leading to a diagnostic gap. In some recent single-center studies, pulse oximetry screening (POS) has been proposed as an effective, noninvasive, inexpensive tool allowing earlier diagnosis of cCHD.Aim of the studyTo test the hypothesis that POS can reduce the diagnostic gap in cCHD in daily clinical routine in the setting of tertiary, secondary and primary care centers.MethodsProspective multicenter trial in Saxony, Germany. POS was performed in healthy term newborns at the age of 24-72 h. Newborns with a prenatal diagnosis or postnatal clinical signs of CHD were excluded. An oxygen saturation value (SpO2) ≥96% for the lower extremities was defined as normal. If a SpO2 of ≤95% was measured and confirmed after 1 h, a complete clinical examination and echocardiography were performed.ResultsFrom July 2006 until June 2007, 21,830 newborns from 31 institutions were included in the study. Thirty-three children were excluded due to prenatal diagnosis (n=22) or clinical signs of cCHD (n=11) before POS, and 506 newborns did not receive POS, mainly due to early discharge after birth (n=438, 87%). In 21,324 newborns, POS was performed. POS was true positive in 7, false positive in 18 (healthy n=6; neonatal sepsis n=2; PPHN n=10), true negative in 21,296, and false negative in 3 children. Sensitivity, specificity, positive and negative predictive value were 70%, 99.92%, 28.0%, and 99.99%, respectively.ConclusionPOS can reduce the postnatal diagnostic gap in cCHD. It can also detect children with sepsis or PPHN. False positive results leading to unnecessary evaluation of healthy newborns are rare. Therefore, POS should be proposed as a routine procedure in postnatal care.