Role of clinical examination and pulse oximetry in screening for congenital heart disease in newborns

Background and objective: This study was designed to evaluate the effectiveness of routine postnatal clinical examination and pulse oximetry screening in detecting congenital  heart  disease  in  newborns. The  aim  of  this  study is  to determine  whether  a  pulse  oximetry  screening  combined  with  clinical examination is superior in the diagnosis of congenital heart disease to clinical examination alone.
Methods: 1000  term  newborn  babies  born  in  tertiary Hospital during the study period of 18 months ( Feb 2017 to May 2018 ) had a thorough clinical examination on day 2 of life with emphasis on  peripheral  pulses,  cyanosis,  tachypnea,  cardiac  pulsations  and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life.  Echocardiogram was done for those babies with either abnormal clinical examination or pulse oximetry reading. Clinical examination was done again 2 weeks after   discharge.
Results: The sensitivity of combined screening was 95.65%, whereas it was 26%   for   oximetry   alone   and    60%   for   clinical   examination alone. Specificity for combined screening was 99.89%, 99.8% for pulse oximetry alone, 98%  for clinical examination alone. The positive predictive value of the combined tool was 95.65%.
Conclusion: Combining pulse oximetry and clinical examination can enhance the clinician’s ability to detect life threatening CHD in a timely manner.