Rosati Enrico, Chitano Giovanna, Dipaola Lucia, De Felice Claudio, Latini Giuseppe
Division of Neonatology, Perrino Hospital, Brindisi, Italy.
J Perinat Med. 2005;33(5):455-7. doi: 10.1515/JPM.2005.080.
Critical congenital cardiovascular malformations (CCVMs) require surgical correction during the first month of life, physical examination is unable to detect >50% of affected infants. An oximetry screening has been previously proposed. Our aim was to verify the usefulness and consistency of a pulse oximetry screening for early detection of CCVMs in a small size nursery.
A single determination of SpO2 was performed on 5292 consecutive apparently healthy newborns, discharged from nursery at a median age of 72 h during the period May 1, 2000 and November 30, 2004. Infants showing signs of congenital heart disease before the screening and those with a prenatal diagnosis were excluded. Cardiac ultrasound was performed on all infants with SpO2< or =95% at >24 h. The accuracy of the screening in identifying CCVMs was assessed by receiver-operating characteristic (ROC) curves analysis.
We found 2 (0.038%) true positives, 1 (0.019%) false negative, 1 (0.019%) false positive, and 5288 (99.92%) true negatives. Prevalence of critical CCVMs was 1 in 1764. Clinical follow-up showed no evidence of CCVMs in the negative cases. A pulse-oximetry cut-off value of < or =95% showed 66.7% sensitivity (95% CI: 11.6-94.5), 100% specificity (95% CI: 99.9-100.0), 50% positive predictive value, 100% negative predictive value and AUC of 0.833 (standard error: 0.145) (95% CI: 0.823 to 0.843) in identifying CCVMs.
Our findings indicate that pulse oximetry is a non-invasive and specific screening tool for an early detection of CCVMs, and is easily applicable to a small size nursery.
严重先天性心血管畸形（CCVMs）需要在出生后第一个月内进行手术矫正，体格检查无法检测出超过50%的患病婴儿。此前已提出进行血氧饱和度筛查。我们的目的是验证脉搏血氧饱和度筛查在小型托儿所中早期检测CCVMs的有效性和一致性。
对2000年5月1日至2004年11月30日期间连续出院的5292例表面健康的新生儿进行单次SpO2测定，这些新生儿的中位出院年龄为72小时。排除筛查前有先天性心脏病迹象的婴儿和产前诊断的婴儿。对所有出生24小时后SpO2≤95%的婴儿进行心脏超声检查。通过受试者操作特征（ROC）曲线分析评估筛查识别CCVMs的准确性。
我们发现2例（0.038%）真阳性、1例（0.019%）假阴性、1例（0.019%）假阳性和5288例（99.92%）真阴性。严重CCVMs的患病率为1/1764。临床随访显示阴性病例中无CCVMs证据。脉搏血氧饱和度临界值≤95%时，在识别CCVMs方面显示出66.7%的敏感性（95%可信区间：11.6 - 94.5）、100%的特异性（95%可信区间：99.9 - 100.0）、50%的阳性预测值、100%的阴性预测值以及0.833的曲线下面积（标准误：0.145）（95%可信区间：0.823至0.843）。
我们的研究结果表明，脉搏血氧饱和度测定是一种用于早期检测CCVMs的非侵入性且特异性的筛查工具，并且易于应用于小型托儿所。
