Should Dual Pulse Oximetry Screening Be Used in Neonates? The Insights from the CHOOSE Study

Abstract

Background: Critical congenital heart disease (CCHD) is a leading cause of neonatal morbidity and mortality. Early detection is crucial to prevent life-threatening complications. Pulse oximetry screening (POS) is a noninvasive method to identify hypoxemia indicative of CCHD, but the optimal timing for screening remains debated. Aim: To evaluate the diagnostic accuracy of dual POS performed at 24–36 h and 48–72 h of life for early detection of CCHD in neonates. Methods: This prospective observational study was conducted over 20 months at a tertiary care neonatal intensive care unit (NICU) in India. A total of 1431 neonates, including term and preterm, underwent POS at two time points. Screening followed the modified American Academy of Pediatrics algorithm, with echocardiographic follow-up for positive screens. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated. Results: Of the enrolled neonates (n = 1431), dual screening identified 95 positives (6.64%): 11 CCHD, 38 noncritical CHD and 46 noncardiac hypoxemic conditions. Dual POS had higher sensitivity (73.33% vs. 60%) and NPV (99.7% vs. 99.54%), and a lower false-negative rate (26.66% vs. 40%). POS 2 detected 2 additional CCHDs missed by POS1. Among 1336 negatives, clinical follow-up found 4 CCHDs. Conclusion: Dual POS significantly improves CCHD detection over single screening while identifying treatable noncardiac hypoxemic conditions. This nurse-led protocol is feasible even in resource-constrained NICUs, warranting routine adoption alongside clinical examination to minimize missed diagnoses of CCHD.

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BibTeX RIS

BibTeX

@article{singh2026should,
  title = {{Should Dual Pulse Oximetry Screening Be Used in Neonates? The Insights from the CHOOSE Study}},
  author = {Neha Singh and Jaya Upadhyay and Monica Lazarus and Shishir Soni},
  journal = {Heart Views},
  year = {2026},
  month = sep,
  doi = {10.4103/heartviews.heartviews_17_26},
  url = {https://doi.org/10.4103/heartviews.heartviews_17_26},
  note = {CC BY-NC-SA},
}

RIS

TY  - JOUR
TI  - Should Dual Pulse Oximetry Screening Be Used in Neonates? The Insights from the CHOOSE Study
AU  - Neha Singh
AU  - Jaya Upadhyay
AU  - Monica Lazarus
AU  - Shishir Soni
PY  - 2026
DA  - 2026/09/01
JO  - Heart Views
DO  - 10.4103/heartviews.heartviews_17_26
UR  - https://doi.org/10.4103/heartviews.heartviews_17_26
AB  - Background: Critical congenital heart disease (CCHD) is a leading cause of neonatal morbidity and mortality. Early detection is crucial to prevent life-threatening complications. Pulse oximetry screening (POS) is a noninvasive method to identify hypoxemia indicative of CCHD, but the optimal timing for screening remains debated. Aim: To evaluate the diagnostic accuracy of dual POS performed at 24–36 h and 48–72 h of life for early detection of CCHD in neonates. Methods: This prospective observational study was conducted over 20 months at a tertiary care neonatal intensive care unit (NICU) in India. A total of 1431 neonates, including term and preterm, underwent POS at two time points. Screening followed the modified American Academy of Pediatrics algorithm, with echocardiographic follow-up for positive screens. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated. Results: Of the enrolled neonates (n = 1431), dual screening identified 95 positives (6.64%): 11 CCHD, 38 noncritical CHD and 46 noncardiac hypoxemic conditions. Dual POS had higher sensitivity (73.33% vs. 60%) and NPV (99.7% vs. 99.54%), and a lower false-negative rate (26.66% vs. 40%). POS 2 detected 2 additional CCHDs missed by POS1. Among 1336 negatives, clinical follow-up found 4 CCHDs. Conclusion: Dual POS significantly improves CCHD detection over single screening while identifying treatable noncardiac hypoxemic conditions. This nurse-led protocol is feasible even in resource-constrained NICUs, warranting routine adoption alongside clinical examination to minimize missed diagnoses of CCHD.
SN  - 1995-705X
SN  - 0976-5123
ER  -

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