Objective To analyze the accuracy and feasibility of combining cardiac auscultation, pulse oximetry (POX) screening, and oxygen therapy assessment for congenital heart disease (CHD) detection in newborns in Guangxi, China, in order to provide basis for wider implementation of this screening strategy. Methods Live newborns delivered in obstetric institutions in Guangxi between January 1st and December 31st, 2021, were enrolled. Cardiac auscultation and POX screening were performed respectively, and the screening results were evaluated in combination with oxygen inhalation. Neonates positive on any screening parameter were classified as CHD screen-positive and further diagnosed by echocardiography. Sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios, and Youden's index were calculated for individual and combined screening measures, and comparisons were made to assess the accuracy of the CHD screening method. Results A total of 469 261 neonates were screened, with 5 199 identified as positive, among whom 3 459 were confirmed cases of CHD. Multivariate analysis revealed that cardiac murmurs (OR=620.17, 95%CI: 564.18 - 681.72), abnormal POX results (OR=235.52, 95%CI: 214.59 - 258.49), and oxygen therapy for ≥72 hours (OR=333.45, 95%CI: 293.76 - 378.50) were independent risk factors for predicting CHD (P＜0.05). The sensitivities for detecting CHD in the murmur group, POX group, and oxygen therapy group were 53.34% (95%CI: 51.66% - 55.01%), 34.32% (95%CI: 32.74% - 35.93%), and 22.23% (95%CI: 20.86% - 23.66%), respectively. The sensitivity rose to 79.73% (95%CI: 78.35% - 81.05%) when combining cardiac auscultation with POX, and further increased to 91.73% (95%CI: 90.75% - 92.62%) upon incorporating oxygen therapy indicators, with the area under the ROC curve reaching 0.96 (95%CI: 0.95% - 0.96%). Conclusions The combination of cardiac auscultation, POX screening, and assessment of oxygen therapy requirements is non-invasive, simple, and reliable, effectively facilitating early detection of CHD in newborns. These findings support the broader application and promotion of this screening approach.
Key words
neonates /
congenital heart disease /
screening /
cardiac auscultation /
pulse oximetry
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