ABSTRACT 541: PULSE OXIMETRY SCREENING IN A PEDIATRIC EMERGENCY DEPARTMENT TO DETECT CONGENITAL HEART DISEASE IN INFANTS UNDER 3 MONTHS OF AGE

Background and aims: Studies have shown that up to 24% of congenital heart disease (CHD) is detected after discharge from birth hospitalization and up to 8% of these present with cardiac decompensation. Pulse oximetry screening for CHD is well described in in the neonatal setting but not beyond this period. Aims: We examined the feasibility of pulse oximetry screening for CHD in a pediatric emergency department (PED). Methods: Infants < 3 months presenting to our PED for any reason between November 2012 and May 2013 were eligible for prospective pre- and postductal pulse oximetry screening. Exclusion criterion was known CHD. Primary outcome was the detection rate of CHD in the PED. A positive screen was defined as any oxygen saturation (SpO2) < 90%, SpO2 < 95% in both extremities or > 3% absolute difference between the right hand and left foot on 3 occasions. Results: None of the 394 of 1451 eligible infants who underwent pulse oximetry screening had a positive test. In the screened group, 4 infants were identified as having CHD by clinical assessment (cardiac murmur and features of heart failure). Sensitivity was 0% and specificity 100%. The median total time taken for SpO2 recording in a subgroup was 3 minutes 33 seconds (range, 50 seconds to 5 minutes). Conclusions: Pulse oximetry screening for CHD in a PED is feasible, but we have not demonstrated additional diagnostic value over standard clinical assessment. Larger, possibly multicentre studies are needed to further examine the utility of pulse oximetry for detecting clinically unrecognisable CHD in the PED.