先天性心脏缺陷是最常见的一种新生儿缺陷，早期发现、早期治疗有助于减少婴儿早夭，对婴儿正常成长和终身健康也有意义。英国一项最新研究说，如果检查婴儿的脉搏血氧，可以发现许多常规检查中漏过的先天性心脏缺陷婴儿。研究人员建议在新生儿体检中加入脉搏血氧检测。
英国伯明翰大学等机构的研究人员在新一期医学刊物《柳叶刀》上报告说，对超过２万名婴儿测试了脉搏血氧检测的有效性。这些婴儿首先接受了常规的出生前超声波检查和出生后体检，其中发现了一些患有先天性心脏缺陷的婴儿，但在通过常规检查的婴儿中，使用脉搏血氧检测又发现了一些先天性心脏缺陷的婴儿。
脉搏血氧检测的测量目标是血液中的氧含量，如果新生婴儿的血氧含量较低，就很有可能患有先天性心脏缺陷。本次研究显示，如果联合使用脉搏血氧检测和常规检查手段，可以检测出９２％的先天性心脏缺陷婴儿。
此外，对于那些检测出血氧含量较低但没有发现先天性心脏缺陷的婴儿，后来也发现其中许多婴儿患有其他需要治疗的疾病。
领导这一研究的安德鲁·尤尔说，现在对新生儿进行脉搏血氧检测很方便。检测仪是非侵入性的，只要把探头贴在婴儿的手和脚上，从仪器上读数就可以了，检测本身的时间往往比给婴儿脱衣服的时间还短。
他说，本次研究为推广脉搏血氧检测提供了有力证据，建议医疗部门将脉搏血氧检测纳入到对新生儿的常规体检中。
生物探索推荐英文论文摘要：
Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study
Background
Screening for congenital heart defects relies on antenatal ultrasonography and postnatal clinical examination; however, life-threatening defects often are not detected. We prospectively assessed the accuracy of pulse oximetry as a screening test for congenital heart defects.
Methods
In six maternity units in the UK, asymptomatic newborn babies (gestation >34 weeks) were screened with pulse oximetry before discharge. Infants who did not achieve predetermined oxygen saturation thresholds underwent echocardiography. All other infants were followed up to 12 months of age by use of regional and national registries and clinical follow-up. The main outcome was the sensitivity and specificity of pulse oximetry for detection of critical congenital heart defects (causing death or requiring invasive intervention before 28 days) or major congenital heart disease (causing death or requiring invasive intervention within 12 months of age).
Findings
20 055 newborn babies were screened and 53 had major congenital heart disease (24 critical), a prevalence of 2·6 per 1000 livebirths. Analyses were done on all babies for whom a pulse oximetry reading was obtained. Sensitivity of pulse oximetry was 75·00% (95% CI 53·29—90·23) for critical cases and 49·06% (35·06—63·16) for all major congenital heart defects. In 35 cases, congenital heart defects were already suspected after antenatal ultrasonography, and exclusion of these reduced the sensitivity to 58·33% (27·67—84·83) for critical cases and 28·57% (14·64—46·30) for all cases of major congenital heart defects. False-positive results were noted for 169 (0·8%) babies (specificity 99·16%, 99·02—99·28), of which six cases were significant, but not major, congenital heart defects, and 40 were other illnesses that required urgent medical intervention.
Interpretation
Pulse oximetry is a safe, feasible test that adds value to existing screening. It identifies cases of critical congenital heart defects that go undetected with antenatal ultrasonography. The early detection of other diseases is an additional advantage.
Funding
National Institute for Health Research Health Technology Assessment programme.
