Razi Journal of Medical Sciences

  Background : Delayed diagnosis of critical and cyanotic congenital heart diseases in asymptomatic newborns can lead to significant morbidity and mortality in this age group. The aim of this study was to determine the utility of hand and foot oxygen saturation as a screening test for the early detection of critical and cyanotic congenital heart diseases in asymptomatic newborns in the first day of life.

  Methods: In this cross-sectional study during a 6 month period we performed hand and foot pulse oximetry in 1506 term and healthy newborns in Shabihkhani Maternity Hospital. Babies with functional oxygen saturation below 95% in either right hand or right foot were considered abnormal and a second saturation measurement was performed 2 hours later. If the repeated measurement was again below 95% they were referred for performing an echocardiogram. The data was analyzed by SPSS version 11.

  Results : During the study period a total of 1506 newborns were screened of whom 1406 cases had SPO₂≥95% in both extremities (mean %97.12±2.20 in right hand and mean %96.9±2.13 in right foot) and 100 babies had SPO₂<95% (mean %93.35±3.17 in right hand and %92.41±3.01 in right foot). The mean SPO₂ in the right foot was lower than the right hand in the both groups. The second saturation measurement was performed 2 hours later on 100 newborns with SPO₂ <95%, of whom 29 had persistent low saturation who were referred for echocardiography. Six asymptomatic babies out of 29 had critical and cyanotic congenital heart diseases (incidence of 4/1000 live births). These diseases were: transposition of great vessels, truncus arteriosus, total anomalous pulmonary venous return and tetralogy of fallot. There was a meaningful correlation between right foot SPO₂ and echocardiography results in newborns with these types of congenital heart diseases (p=0.004)

  Conclusion: According to the significance of diagnosis of congenital heart disease, pulse oximetry screening along with clinical examination could help in the early detection of critical and cyanotic congenital heart diseases in asymptomatic newborns. Performing right foot pulse oximetry seems to be adequate for screening, because in all the circumstances it was lower than hand saturation.