Division of Neonatology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN 37232-9550, USA.
J Perinatol. 2011 Feb;31(2):125-9. doi: 10.1038/jp.2010.70. Epub 2010 May 27.
Pulse oximetry screening of asymptomatic newborns is suggested as a life-saving procedure for the timely detection of critical congenital heart disease (CHD) in asymptomatic newborns. We evaluated this screening and report cases that demonstrate problems with screening in a non-research setting.
An elective state-directed public health screening program was evaluated in Middle Tennessee; 14 564 infants were screened after 24 h of age and before discharge. The screening was performed in a non-research setting by nurses at the local hospitals. A parallel investigation of the methods and timing of diagnosis in Middle Tennessee revealed a surprisingly high incidence of antenatal diagnosis (66%).
Using a saturation value of 94% as the defined normal, the positive predictive value was less than 1%, with 112 infants having a false positive case and 1 having a true positive case identified (incidence 1/34 775). The one true positive case was not referred for evaluation. One false-positive case resulted in a costly referral and hospitalization. Antenatal diagnosis when combined with physical examination detected 43 of 44 infants with critical CHD during the year-long evaluation.
Before universal screening can be implemented, a system of care must be defined to address the educational and referral issues raised by this report.
脉搏血氧仪筛查无症状新生儿被认为是一种救命程序，可及时发现无症状新生儿的严重先天性心脏病（CHD）。我们评估了这种筛查，并报告了在非研究环境中筛查出现问题的病例。
在田纳西州中部评估了一项选择性的州政府主导的公共卫生筛查计划；在 24 小时后至出院前，对 14564 名婴儿进行了筛查。筛查是由当地医院的护士在非研究环境中进行的。对田纳西州中部的诊断方法和时间的平行调查显示，产前诊断的发生率惊人地高（66%）。
以饱和度值 94%为正常定义，阳性预测值小于 1%，112 名婴儿出现假阳性病例，1 名婴儿出现真阳性病例（发病率为 1/34775）。一例真阳性病例未被转介评估。一例假阳性病例导致昂贵的转诊和住院治疗。产前诊断结合体格检查在为期一年的评估中发现了 44 例严重 CHD 患儿中的 43 例。
在实施普遍筛查之前，必须定义一个护理系统，以解决本报告提出的教育和转介问题。
