Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns
Background: Newborns with a critical congenital heart disease left undiagnosed and untreated have a substantial risk for serious complications and subsequent failure to thrive. Prenatal ultrasound screening is not widely available, nor is postnatal echocardiography. Physical examination is the stand...
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| Format: | Article |
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MDPI AG
2023-12-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/11/1/47 |
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| author | Jari T. van Vliet Naizihijwa G. Majani Pilly Chillo Martijn G. Slieker |
| author_facet | Jari T. van Vliet Naizihijwa G. Majani Pilly Chillo Martijn G. Slieker |
| author_sort | Jari T. van Vliet |
| collection | DOAJ |
| description | Background: Newborns with a critical congenital heart disease left undiagnosed and untreated have a substantial risk for serious complications and subsequent failure to thrive. Prenatal ultrasound screening is not widely available, nor is postnatal echocardiography. Physical examination is the standard for postnatal screening. Pulse oximetry has been proposed in numerous studies as an alternative screening method. This systematic review and meta-analysis aims to determine the diagnostic accuracies of both screening methods separately and combined. Methods: A systematic literature search of the Embase, PubMed, and Global Health databases up to 30 November 2023 was conducted with the following keywords: critical congenital heart disease, physical examination, clinical scores, pulse oximetry, and echocardiography. The search included all studies conducted in the newborn period using both physical examination and pulse oximetry as screening methods and excluded newborns admitted to the intensive care unit. All studies were assessed for risk of bias and applicability concerns using the QUADAS-2 score. The review adhered to the PRISMA 2020 statement guideline. Results: Out of 2711 articles, 20 articles were selected as eligible for meta-analysis. Cumulatively, the sample included 872,549 screened newborns. The pooled sensitivity of the physical examination screening method was found to be 0.69 (0.66–0.73 (95% CI)) and specificity was found to be 0.98 (0.98–0.98). For the pulse oximetry screening method, the pooled sensitivity and specificity yielded 0.78 (0.75–0.82) and 0.99 (0.99–0.99), respectively. The combined method of screening yielded improved diagnostic characteristics at a sensitivity and specificity of 0.93 (0.91–0.95) and 0.98 (0.98–0.98, respectively. Conclusions: The evidence indicates that combining both physical examination and pulse oximetry to screen for critical congenital heart disease exceeds the accuracy of either separate method. The main limitation is that solely newborns with suspected critical congenital heart disease were subjected to the reference standard. We recommend adapting both methods to screen for critical congenital heart diseases, especially in settings lacking standard fetal ultrasound screening. To increase the sensitivity further, we recommend increasing the screening time window and employing the peripheral perfusion index. |
| first_indexed | 2024-03-08T11:02:05Z |
| format | Article |
| id | doaj.art-51ecbb3f78ef445c9a654592c4108cce |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-08T11:02:05Z |
| publishDate | 2023-12-01 |
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| series | Children |
| spelling | doaj.art-51ecbb3f78ef445c9a654592c4108cce2024-01-26T15:46:54ZengMDPI AGChildren2227-90672023-12-011114710.3390/children11010047Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in NewbornsJari T. van Vliet0Naizihijwa G. Majani1Pilly Chillo2Martijn G. Slieker3Department of Pediatric Cardiology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The NetherlandsDepartment of Pediatric Cardiology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The NetherlandsDepartment of Internal Medicine, School of Medicine, Faculty of Adult Cardiology, Muhimbili Campus, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, TanzaniaDepartment of Pediatric Cardiology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The NetherlandsBackground: Newborns with a critical congenital heart disease left undiagnosed and untreated have a substantial risk for serious complications and subsequent failure to thrive. Prenatal ultrasound screening is not widely available, nor is postnatal echocardiography. Physical examination is the standard for postnatal screening. Pulse oximetry has been proposed in numerous studies as an alternative screening method. This systematic review and meta-analysis aims to determine the diagnostic accuracies of both screening methods separately and combined. Methods: A systematic literature search of the Embase, PubMed, and Global Health databases up to 30 November 2023 was conducted with the following keywords: critical congenital heart disease, physical examination, clinical scores, pulse oximetry, and echocardiography. The search included all studies conducted in the newborn period using both physical examination and pulse oximetry as screening methods and excluded newborns admitted to the intensive care unit. All studies were assessed for risk of bias and applicability concerns using the QUADAS-2 score. The review adhered to the PRISMA 2020 statement guideline. Results: Out of 2711 articles, 20 articles were selected as eligible for meta-analysis. Cumulatively, the sample included 872,549 screened newborns. The pooled sensitivity of the physical examination screening method was found to be 0.69 (0.66–0.73 (95% CI)) and specificity was found to be 0.98 (0.98–0.98). For the pulse oximetry screening method, the pooled sensitivity and specificity yielded 0.78 (0.75–0.82) and 0.99 (0.99–0.99), respectively. The combined method of screening yielded improved diagnostic characteristics at a sensitivity and specificity of 0.93 (0.91–0.95) and 0.98 (0.98–0.98, respectively. Conclusions: The evidence indicates that combining both physical examination and pulse oximetry to screen for critical congenital heart disease exceeds the accuracy of either separate method. The main limitation is that solely newborns with suspected critical congenital heart disease were subjected to the reference standard. We recommend adapting both methods to screen for critical congenital heart diseases, especially in settings lacking standard fetal ultrasound screening. To increase the sensitivity further, we recommend increasing the screening time window and employing the peripheral perfusion index.https://www.mdpi.com/2227-9067/11/1/47newborn screeningcritical congenital heart diseasepulse oximetry |
| spellingShingle | Jari T. van Vliet Naizihijwa G. Majani Pilly Chillo Martijn G. Slieker Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns Children newborn screening critical congenital heart disease pulse oximetry |
| title | Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns |
| title_full | Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns |
| title_fullStr | Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns |
| title_full_unstemmed | Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns |
| title_short | Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns |
| title_sort | diagnostic accuracy of physical examination and pulse oximetry for critical congenital cardiac disease screening in newborns |
| topic | newborn screening critical congenital heart disease pulse oximetry |
| url | https://www.mdpi.com/2227-9067/11/1/47 |
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