6: Towards Pulse Oximetry Screening in Ontario, Canada: What is the Burden of Missed Critical Congenital Heart Disease?

Abstract

Pulse oximetry screening (POS) for critical congenital heart disease (CCHD) in newborns is gaining acceptance in clinical practice. The geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges with regards to POS implementation. Evaluate the incidence of missed CCHD cases and the trends over time in Ontario, Canada over 10 years as a first step towards consideration of POS. Data from multiple, linked, administrative health and demographic datasets were used to determine the annual incidence of total and missed cases of CCHD in Ontario from 2002–11, along with baseline demographics including designated level of birth hospital. Patients discharged home prior to diagnosis of CCHD were considered to have “missed CCHD” and were further subcategorized into “definitely missed” [1 of 9 pre-determined severest CCHDs and re-admission within 30 days or death] and “possibly missed” [1 of 6 less severe CCHDs requiring readmission in first year of life resulting in either cardiac intervention or death]. Annual trends in incidence of missed CCHD were evaluated during study period. Of 1,343,850 total births in Ontario during the study period, 2787 (0.21%) had a diagnosis of CCHD and 438 (15.7%) cases of CCHD were missed. Of these 438 patients, 66 were definitely and 372 were possibly missed CCHD cases and the proportion delivered in hospitals without neonatal intensive care capability was 77.3% and 82.5%, respectively. There was no discernible change in the incidence of missed CCHD cases over the ten year period. Despite a low overall incidence of CCHD, a significant proportion of CCHD cases were not diagnosed prior to discharge home, and the vast majority were delivered in non-tertiary hospitals. Further research is required to evaluate the logistical and economic impact of POS implementation in Ontario in light of these data.