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Pulse oximetry screening of neonates at four hours of age is not effective in detecting critical congenital heart defects, Dallas-based researchers report.

Pulse oximetry screening of neonates at four hours of age is not effective in detecting critical congenital heart defects, Dallas-based researchers report in the October issue of Pediatrics. In fact, pulse oximetry screening failed to detect any critical congenital heart defects in a large series of newborns over a 12-month period.

"Based on screening over 15,000 infants," lead investigator Dr. Dorothy M. Sendelbach told Reuters Health, "we found that good clinical evaluation is superior to screening pulse oximetry in detecting critical congenital heart disease."

Dr. Sendelbach and colleagues at the University of Texas Southwestern Medical Center came to this conclusion after studying stable hospital-born neonates. The infants had a gestational age of at least 35 weeks, a birth weight of 2100 g or more, and were not suspected to have a critical heart defect.

Pulse oximetry screening results showed readings at or beyond 96 per cent in 94.4 per cent of the neonates. However, 77 of this group were evaluated clinically prior to discharge and one was found to have tetralogy of Fallot with discontinuous pulmonary arteries.

Seven hundred sixty-eight of 859 neonates who showed readings below 96 per cent at four hours were rescreened, and all but one infant had levels at or above 96 per cent at that point. This infant had persistently low levels, but normal echocardiography.

However, three infants in this group received a diagnosis of a critical congenital heart defect. The researchers stress that this was achieved on the basis of clinical findings, not screening results.

Given the poor performance of pulse oximetry in apparently healthy neonates, Dr. Sendelbach's group concludes that pulse oximetry screening offers no improvements over clinical examination and is not recommended for use in routine screening of neonates.

Pediatrics 2008;122:e815-e820