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Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

Published online by Cambridge University Press:  28 September 2020

Sruti Rao Open the ORCID record for Sruti Rao [Opens in a new window] ,
M. B. Goens ,
Orrin B. Myers  and
Emilie A. Sebesta
Sruti Rao*
Affiliation:
Division of Pediatric Cardiology, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
M. B. Goens
Affiliation:
Division of Pediatric Cardiology, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
Orrin B. Myers
Affiliation:
Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
Emilie A. Sebesta
Affiliation:
Department of Pediatrics, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
*
Author for correspondence: Sruti Rao, MD, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE19803, USA. E-mail: soodsr11@gmail.com
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Abstract

Aim:

To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time.

Methods:

We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time.

Results:

Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = −0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88–0.97) per month.

Conclusion:

This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.

Keywords

Pulse oximetry screeninghigh altitudefalse positivecritical congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1851 - 1855
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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