Abstract
Objective: To assess the effect of routine measurement of postductal oxygen saturation as an adjunct to routine clinical examination in the asymptomatic newborn.
Design and setting: Prospective study in a district general hospital.
Patients: All 6166 infants inborn between 1 April 1999 and 31 March 2001.
Intervention: Oxygen saturation was measured over two minutes, after the age of 2 hours and before discharge, in one foot of all babies not admitted directly to the neonatal unit. Babies with fractional (as opposed to functional) oxygen saturation (SaO2) below 95% were examined by the midwife. If this examination was abnormal or if normal but further measurements were below 95%, an echocardiogram was performed. All babies with cardiac malformations diagnosed by 1 year of age were identified from databases maintained at the regional cardiology referral unit and the regional congenital malformation survey.
Results: Measurements were made in 98% of eligible babies. A fractional SaO2 less than 95% was found in 5% but persisted in only 1%. Structural cardiac malformations were found in 50 (8.1/1000), 26 of whom had isolated ventricular septal defects. Of the remaining 24 with other cardiac malformations, attention was first drawn to six by low SaO2, and four more, first noticed for other reasons, also had low SaO2. Low SaO2 also first drew attention to 13 other babies ill for other reasons.
Conclusion: Newborn babies with important cardiac malformations are often asymptomatic initially and the yield from clinical examination is poor. Measuring postductal saturation routinely in newborn babies before discharge is easy and can alert staff to ill babies.
Full Text
The Full Text of this article is available as a PDF (239.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abu-Harb M., Hey E., Wren C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child. 1994 Jul;71(1):3–7. doi: 10.1136/adc.71.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Abu-Harb M., Wyllie J., Hey E., Richmond S., Wren C. Presentation of obstructive left heart malformations in infancy. Arch Dis Child Fetal Neonatal Ed. 1994 Nov;71(3):F179–F183. doi: 10.1136/fn.71.3.f179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ainsworth S., Wyllie J. P., Wren C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed. 1999 Jan;80(1):F43–F45. doi: 10.1136/fn.80.1.f43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bonnet D., Coltri A., Butera G., Fermont L., Le Bidois J., Kachaner J., Sidi D. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation. 1999 Feb 23;99(7):916–918. doi: 10.1161/01.cir.99.7.916. [DOI] [PubMed] [Google Scholar]
- Katzman G. H. The newborn's SpO2: a routine vital sign whose time has come? Pediatrics. 1995 Jan;95(1):161–162. [PubMed] [Google Scholar]
- Poets C. F., Southall D. P. Noninvasive monitoring of oxygenation in infants and children: practical considerations and areas of concern. Pediatrics. 1994 May;93(5):737–746. [PubMed] [Google Scholar]
- Pollitt R. J., Green A., McCabe C. J., Booth A., Cooper N. J., Leonard J. V., Nicholl J., Nicholson P., Tunaley J. R., Virdi N. K. Neonatal screening for inborn errors of metabolism: cost, yield and outcome. Health Technol Assess. 1997;1(7):i-iv, 1-202. [PubMed] [Google Scholar]
- Wren C., Richmond S., Donaldson L. Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed. 1999 Jan;80(1):F49–F53. doi: 10.1136/fn.80.1.f49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wren C., Richmond S., Donaldson L. Temporal variability in birth prevalence of cardiovascular malformations. Heart. 2000 Apr;83(4):414–419. doi: 10.1136/heart.83.4.414. [DOI] [PMC free article] [PubMed] [Google Scholar]