Educative power point presentation for trainees / post graduate students/ fellows in paediatrics/ paediatric cardiology/ paediatric critical care/ neonatology / emergency paediatrics

1. PULSE OXIMETRY IN THE DIAGNOSIS
OF NEONATES WITH CONGENITAL
HEART DISEASES
Dr Isha Deshmukh
Assistant Professor
BJGMC, Pune

2. DR ISHA DESHMUKH

3. PRIMARY OBJECTIVES OF A PEDIATRICIAN
 To detect Congenital Abnormalities at birth
 Early identification of neonates with suspected
congenital heart lesions
 To identify easy method for appropriate
diagnosis and treatment
 Through clinical examination by medical
personal
 Adjuvant Laboratory screening
 Adjuvant radiology
 Adjuvant Echocardiography

4. CRITERIA DESCRIBED FOR UNIVERSAL SCREENING
FOR DIAGNOSIS OF CHD BY PULSE-OXIMETRY
1. Important public health problem
2. Accepted treatment for condition
3. Facilities for diagnosis and treatment
4. Early symptomaticity of CHD
5. Suitable test for screening
6. Natural history of the disease to be understood
7. Agreed policy for treatment
8. Cost of investigation
9. Continuing project

5.  Neonates with respiratory distress, cyanosis or
dysmorphic syndromes commonly have CHD.
 Clinical suspicion increase in a symptomatic infant
with a cardiac murmur, but the presence or
absence of a murmur does not assure either the
presence or absence of significant CHD.
 D/D
1. Respiratory disease
2. ACHD with CCF
3. CCHD with PPHT
4. Shock in neonates

6. US algorithm. ox, oximetry.
Andrew K. Ewer, and Gerard R. Martin Pediatrics
2016;138:e20161206
©2016 by American Academy of Pediatrics

7. Failed Screen: A screen is considered failed if
 Any oxygen saturation measure is <90% (in the
initial screen or in repeat screen)
 Oxygen saturation is <95% in the right hand and
foot on three measures, each separated by one
hour or
 A saturation >3% difference exists in oxygen
saturation between the right hand and foot on three
measures, each separated by one hour.
 Any infant who fails the screen should have an
evaluation for causes of hypoxemia. If a reversible
cause of hypoxemia is identified and appropriately
treated, an echocardiogram may not be necessary.

8. Passed screens
 Any screening with an oxygen saturation measure
that is >95% in the right hand or foot with a <3%
absolute difference between the right hand and
foot is considered a passed screen and screening
should end.
 To reduce false positive screens, screen the
neonate while baby is alert or after 24 hours old.

9. ASSOCIATED RESEARCH ON SIMILAR TOPICS
 Cross sectional study done in 2011 in Mexico
 Pulse-oximetry (PO) was determined before
neonatal hospital discharge and in case of post
ductal oxygen saturation <95%, a Doppler
Echocardiogram was performed.
Conclusion:
 PO had a good sensitivity and specificity for the
identification of CHD in neonates.
 Low oxygen saturation, higher respiratory
frequency and early post-natal age were related
to CHD.

10. AN UP-TO DATE STUDY IN 2017
 Pulse –oximetry (PO) is safe, feasible and non-
invasive method for screening CHD.
 It is a nice method to detect the CHD along-with
the physical evaluation by medical personal.

11. STUDY DONE IN 2015 BY ANTINO ABERTO
ZUPPA ET AL IN ITALY
 To assess the sensitivity , specificity , positive
predictive value and negative predictive value of
the cardiovascular physical examination CPE
and of PO in asymptomatic newborn when
prenatal USG is negative for structural cardiac
anomalies.
 Conclusion: The association of CPE and PO
allows to further improve the diagnostic
accuracy.

12. STUDY INFERENCE FROM BMJ
ARCHIEVES OF CHILDHOOD DISEASES
Conclusion:
 PO showed a high specificity 99.99% and overall
detection rate of detection of neonatal CHD with
PO was 72% exceeding that of clinical
examination 58%.

13. THANKS FOR THE PATIENT LISTENING ....