Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Children：A Systematic Review and Meta-Analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YOU Tao , LIU Xingguang , WANG Xinkuan , HOU Xiaodong , DING Fan , DING Zhaohong , ZHANG Chen , YI Kang.

Department of Cardiovascular Surgery，People’s Hospital of Gansu Province，Lanzhou 730000，P. R. China;

Corresponding author：

Keywords：

Pulse oximetry; 　Congenital heart disease; 　Diagnosis; 　Systematic review; 　Meta-analysis

DOI：

10.7507/1007-4848.20130213

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Objective To investigate the accuracy of pulse oximetry screening for congenital heart disease （CHD） in asymptomatic children. Methods We electronically searched VIP database，CNKI database，CBMdisc，Wanfandatabase，PubMed，Excerpta Medica Database （EMBASE） and the Cochrane Library from the time of database establishment to February 2013 to identify literatures regarding pulse oximetry screening for CHD in asymptomatic children. Data extraction was performed by two researchers independently. Quality of the included literatures was evaluated with qualityassessment for diagnostic accuracy studies （QUADAS）. Meta-analysis was performed using RevMan 5.1.1. ResultsTwelve studies were included in this study with a total of 137 582 newborns. Fourteen QUADAS criteria were fulfilled by all the 12 studies. Among the 12 studies，only the studies with positive test results received verification using a gold standardtest，and the execution of the gold standard test was described in sufficient detail only in 1 study. There were 10 studies in which the gold standard test results were interpreted with knowledge of the diagnostic test results. Meta-analysis showed that pooled sensitivity and specificity of pulse oximetry test for the diagnosis of CHD were 22% with 95% CI （19%，25%） and 99% （99%，99%） respectively. Pooled positive likelihood ratio （LR＋） and negative likelihood ratio （LR-） were 157.30 with 95% CI （11.80，2 096.95） and 0.61 with 95% CI （0.46，0.82） respectively. Pooled diagnostic odds ratio was 398.25 （34.5，4 596.81）. The area under summary receiver operating characteristic （SROC） curve was 0.809，and Q index was 0.744. Conclusion Pulse oximetry is a lowly sensitive and highly specific diagnostic method for children with CHD，and is helpful for early diagnosis of CHD.

Citation： YOU Tao,LIU Xingguang,WANG Xinkuan,HOU Xiaodong,DING Fan,DING Zhaohong,ZHANG Chen,YI Kang.. Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Children：A Systematic Review and Meta-Analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 961-697. doi: 10.7507/1007-4848.20130213 Copy

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2.	Jie H， Kaplan S. The incidence of congenital heart disease. JACC， 2002， 39 （12）：1890-1900.
3.	黄晶晶，刘弘涛，刘红霞. 胎儿超声心动图产前诊断先天性心脏病的临床价值流行病学评价. 国外医学心血管分册， 2007， 28 （5）：266-268.
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5.	Malkin JD， Garber S， Broder MS， et al. Infant mortality and early postpartum discharge. Obstet Gynecol， 2000， 96 （2）：183-188.
6.	Meberg A， Otterstad JE， Froland G， et al. Early clinical screening of neonates for congenital heart disease：the cases we miss. Cardiol Young， 1999， 9 （2）：169-174.
7.	王慧琴. 新生儿先天性心脏病的早期诊断及内科治疗. 新生儿科杂志， 2005， 20 （3）：119-121.
8.	Hall DMB， Elliman D. Health for all children， 4th edn. Oxford：Oxford University Press， 2003.
9.	Wren C， Richmond S， Donaldson L. Presentation of congenital heart disease in pregnancy：Implications for routine examination. Arch Dis Child Fetal Neonatal Ed， 1999， 80 （1）：F49-F53.
10.	Salwyer JW. Neonatal and pediatric pulse oximetry. Respir Care， 2003， 48 （4）：386-396.
11.	Arlettaz R， Bauschatz AS， Mönkhoff M， et al. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr， 2006， 165 （2）：94-98.
12.	Bakr AF， Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol， 200526 （6）：832-835.
13.	de Wahl Granelli A， Mellander M， Sunnegårdh J， et al. Screening for duct-dependant congenital heart disease with pulse oximetry：a critical evaluation of strategies to maximize sensitivity. Acta Paediatr，2005， 94 （11）：1590-1596.
14.	Hoke TR， Donohue PK， Bawa PK， et al. Oxygen saturation as a screening test for critical congenital heart disease：a preliminary study. Pediatr Cardiol， 2002， 23 （4）：403-409.
15.	Koppel RI， Druschel CM， Carter T， et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics， 2003， 111 （3）：451-455.
16.	Reich JD， Miller S， Brogdon B， et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr， 2003， 142 （3）：268-272.
17.	Richmond S， Reay G， Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed， 2002， 87 （2）：83-88.
18.	Rosati E， Chitano G， Dipaola L， et al. Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease. J Perinat Med， 2005， 33 （5）：455-457.
19.	Whiting PF， Weswood ME， Rutjes AW， et al. Evaluation of QUADAS，a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Melhodol， 2006， 6 （1）：9.
20.	Walsh W. Evaluation of pulse oximetry screening in Middle Tennessee：cases for consideration before Universal screening. J Perinatol， 2011， 31 （2）：125-129.
21.	Vaidyanathan B， Sathish G， Mohanan ST， et al. Clinical screening for Congenital heart disease at birth：a prospective study in a community hospital in Kerala. Indian Pediatr， 2011， 48 （1）：25-30.
22.	Richmond S， Reay G， Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed， 2002， 87 （2）：83-88.
23.	Riede FT， Wörner C， Dähnert I， et al. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heartdisease in daily clinical routine--results from a prospective multicenterstudy. Eur J Pediatr， 2010， 169 （8）：975-981.
24.	Granelli AD， Mellander M， Sunnegardh J， et al. Screening for duct dependant congenital heart diseae with pulse oximetry：a criticalevaluation of strategies to maximize sensitivity. Acta Paediatr， 2005， 94 （11）：1590-1596.
25.	de-Wahl Granelli A， Wennergren M， Sandberg K， et al. Impact of pulse oximetry screening on the detection of duct dependent congenitalheart disease：a Swedish prospective screening study in 39， 821newborns. BMJ， 2009， 338 （3037）：a3037.
26.	Knowles R， Griebsch I， Dezateux C， et al. Newborn screening for congenital heart defects：a systematic review and cost-effectiveness analysis. Health Technol Assess， 2005， 9 （44）：1-152.
27.	The Cochrane Collaboration. Cochrane Methods Working Group on Systematic Reviews of Screening and Diagnostic Tests：RecommendedMethods. 6 June， 1996. http：//www. Cochrane. Org/newslett（accessed 24 March 2007）.
28.	Lijmer JG， Mol BW， Heisterkamp S， et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA， 1999， 282 （11）：1061-1066.

1. 　Bruneau BG. The developmental genetics of congenital heart disease. Nature， 2008， 451 （7181）：943-948.
2. 　Jie H， Kaplan S. The incidence of congenital heart disease. JACC， 2002， 39 （12）：1890-1900.
3. 　黄晶晶，刘弘涛，刘红霞. 胎儿超声心动图产前诊断先天性心脏病的临床价值流行病学评价. 国外医学心血管分册， 2007， 28 （5）：266-268.
4. 　马向洁，高文华. 新生儿先天性心脏病早期诊断. 中国医学文摘：儿科学， 2006， 25 （2）：83.
5. 　Malkin JD， Garber S， Broder MS， et al. Infant mortality and early postpartum discharge. Obstet Gynecol， 2000， 96 （2）：183-188.
6. 　Meberg A， Otterstad JE， Froland G， et al. Early clinical screening of neonates for congenital heart disease：the cases we miss. Cardiol Young， 1999， 9 （2）：169-174.
7. 　王慧琴. 新生儿先天性心脏病的早期诊断及内科治疗. 新生儿科杂志， 2005， 20 （3）：119-121.
8. 　Hall DMB， Elliman D. Health for all children， 4th edn. Oxford：Oxford University Press， 2003.
9. 　Wren C， Richmond S， Donaldson L. Presentation of congenital heart disease in pregnancy：Implications for routine examination. Arch Dis Child Fetal Neonatal Ed， 1999， 80 （1）：F49-F53.
10. 　Salwyer JW. Neonatal and pediatric pulse oximetry. Respir Care， 2003， 48 （4）：386-396.
11. 　Arlettaz R， Bauschatz AS， Mönkhoff M， et al. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr， 2006， 165 （2）：94-98.
12. 　Bakr AF， Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol， 200526 （6）：832-835.
13. 　de Wahl Granelli A， Mellander M， Sunnegårdh J， et al. Screening for duct-dependant congenital heart disease with pulse oximetry：a critical evaluation of strategies to maximize sensitivity. Acta Paediatr，2005， 94 （11）：1590-1596.
14. 　Hoke TR， Donohue PK， Bawa PK， et al. Oxygen saturation as a screening test for critical congenital heart disease：a preliminary study. Pediatr Cardiol， 2002， 23 （4）：403-409.
15. 　Koppel RI， Druschel CM， Carter T， et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics， 2003， 111 （3）：451-455.
16. 　Reich JD， Miller S， Brogdon B， et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr， 2003， 142 （3）：268-272.
17. 　Richmond S， Reay G， Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed， 2002， 87 （2）：83-88.
18. 　Rosati E， Chitano G， Dipaola L， et al. Indications and limitations for a neonatal pulse oximetry screening of critical congenital heart disease. J Perinat Med， 2005， 33 （5）：455-457.
19. 　Whiting PF， Weswood ME， Rutjes AW， et al. Evaluation of QUADAS，a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Melhodol， 2006， 6 （1）：9.
20. 　Walsh W. Evaluation of pulse oximetry screening in Middle Tennessee：cases for consideration before Universal screening. J Perinatol， 2011， 31 （2）：125-129.
21. 　Vaidyanathan B， Sathish G， Mohanan ST， et al. Clinical screening for Congenital heart disease at birth：a prospective study in a community hospital in Kerala. Indian Pediatr， 2011， 48 （1）：25-30.
22. 　Richmond S， Reay G， Abu Harb M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed， 2002， 87 （2）：83-88.
23. 　Riede FT， Wörner C， Dähnert I， et al. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heartdisease in daily clinical routine--results from a prospective multicenterstudy. Eur J Pediatr， 2010， 169 （8）：975-981.
24. 　Granelli AD， Mellander M， Sunnegardh J， et al. Screening for duct dependant congenital heart diseae with pulse oximetry：a criticalevaluation of strategies to maximize sensitivity. Acta Paediatr， 2005， 94 （11）：1590-1596.
25. 　de-Wahl Granelli A， Wennergren M， Sandberg K， et al. Impact of pulse oximetry screening on the detection of duct dependent congenitalheart disease：a Swedish prospective screening study in 39， 821newborns. BMJ， 2009， 338 （3037）：a3037.
26. 　Knowles R， Griebsch I， Dezateux C， et al. Newborn screening for congenital heart defects：a systematic review and cost-effectiveness analysis. Health Technol Assess， 2005， 9 （44）：1-152.
27. 　The Cochrane Collaboration. Cochrane Methods Working Group on Systematic Reviews of Screening and Diagnostic Tests：RecommendedMethods. 6 June， 1996. http：//www. Cochrane. Org/newslett（accessed 24 March 2007）.
28. 　Lijmer JG， Mol BW， Heisterkamp S， et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA， 1999， 282 （11）：1061-1066.

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