脉搏血氧饱和度筛查在非导管依赖型青紫型先天性心脏病新生儿中的应用：值得警惕吗？
Utility of pulse-oximetry screening in newborns with nonductus-dependent cyanotic congenital heart defects: A reason to alarm?
作者信息
Arvind Balaji, Saxena Anita, Ramakrishnan Sivasubramanian
机构信息
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Pt BD Sharma University of Health Sciences, Rohtak, Haryana, India.
出版信息
Ann Pediatr Cardiol. 2022 Jan-Feb;15(1):41-43. doi: 10.4103/apc.apc_9_22. Epub 2022 Jun 14.
OBJECTIVES
We aimed to compare the performance of pulse-oximetry screening in detecting nonductus-dependent cyanotic congenital heart defects (CCHDs).
METHODS
In a prospective cross-sectional study, we recorded post ductal saturation of neonates (<48 h old) born at a community hospital in northern India. Subsequently, all underwent clinical examination and echocardiogram by a trained cardiologist. A saturation <95% was considered a "failed" screen.
RESULTS
Ten neonates were identified to have nonductus-dependent CCHD on echocardiogram, five of whom had passed pulse-oximetry screen. This translated to a sensitivity of 50% (95% confidence interval [CI] 23.7%-76.3%) and a positive predictive value of 0.08 (95% CI 0.03-0.2), both of which were significantly less compared to that in ductus-dependent congenital heart defect.
CONCLUSIONS
Up to half of the nonductus-dependent CCHD may be missed if screened only using pulse oximetry. Parents should not be reassured regarding the absence of CCHD only based on a "pass" in pulse-oximetry screening.
目的
我们旨在比较脉搏血氧饱和度筛查在检测非导管依赖型青紫型先天性心脏病（CCHD）方面的表现。
方法
在一项前瞻性横断面研究中，我们记录了印度北部一家社区医院出生的新生儿（<48小时）动脉导管后的血氧饱和度。随后，所有新生儿均由一名训练有素的心脏病专家进行临床检查和超声心动图检查。饱和度<95%被视为筛查“失败”。
结果
超声心动图检查发现10例新生儿患有非导管依赖型CCHD，其中5例通过了脉搏血氧饱和度筛查。这意味着敏感性为50%（95%置信区间[CI]23.7%-76.3%），阳性预测值为0.08（95%CI 0.03-0.2），与导管依赖型先天性心脏病相比，两者均显著降低。
结论
如果仅使用脉搏血氧饱和度进行筛查，高达一半的非导管依赖型CCHD可能会被漏诊。仅基于脉搏血氧饱和度筛查的“通过”结果就使家长对不存在CCHD放心是不可取的。
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