An Ideal Neonatal Congenital Heart Disease Screening Plan by Pulse Oximeter and Auscultation in a Large Single Center

Purpose To investigate the feasibility and reliability of pulse oximeter (POX) as a fast-screening device for congenital heart disease (CHD) through comparing performances of cardiac auscultation and POX in a large retrospective single center study. Methods Every newborn received auscultation and POX tests separately. When an abnormal murmur or SpO2 level is detected, an echocardiogram will be ordered to confirm the diagnosis of CHD in the newborn. Results From January 1, 2018 to December 31, 2019, there were 44,147 livebirths at the studied hospital where 498 newborns were diagnosed with CHD: 27 newborns by POX screening and 471 by cardiac auscultation. The diagnosis was further confirmed in 458 neonates through echocardiogram. This result puts forth an overall diagnosis rate of 91.97%. Cardiac auscultation detected the majority of CHD cases 438 (95.6%) while POX only screened 20 (4.4%) cases. Interestingly, no CHD case was detected by both auscultation examination and POX screening. Auscultation detected most of the common types of CHD, but POX excelled in identifying rare and critical cases. POX screening alone had a very low accuracy of 3.41% in positive predict value (PPV). On the other hand, auscultation can function well in terms of PPV and negative predict value (NPV) (92.99% and 99.95%, respectively), but the addition of POX could improve the overall screening performance and reach NPV to 100%. We also validate the finding with the data six months after the study period. Conclusion Auscultation screening operates well in detecting common CHDs whereas POX screening excels in distinguishing rare, yet critical, cases of CHDs. Therefore, an ideal CHD screening plan should combine cardiac auscultation and POX screening.