Newborn Pulse Oximetry Screening Research Articles

Pulse Oximetry Screening for Detection of Critical Congenital Heart Defects at an Altitude of 5400 Feet at a Tertiary Care Center in New Mexico

Purpose: Universal newborn pulse oximetry screening to detect critical congenital heart disease (CHD) has become the standard of care in the United States. Using the newborn pulse oximetry screening protocol recommended by the Secretary';s Advisory Committee on Heritable Disorders in Newborns and Children, American Academy of Pediatrics and American Heart Association, we sought to determine the false positive rate at moderate altitude, which we hypothesized would be considerably higher than that recorded at sea level. Methods: Data was collected retrospectively from July 2012 to October 2013. Infants with a gestational age of at least 36 weeks and weighing …

Feasibility study assessing equitable delivery of newborn pulse oximetry screening in New Zealand’s midwifery-led maternity setting

ObjectivesThe aim of this study was to conduct New Zealand-specific research to inform the design of a pulse oximetry screening strategy that ensures equity of access for the New Zealand...

Cost-effectiveness analysis of newborn pulse oximetry screening to detect critical congenital heart disease in Colombia

BackgroundIn many countries, economic assessments of the routine use of pulse oximetry in the detection of Critical Congenital Heart Disease (CCHD) at birth has not yet been carried out. CCHDs necessarily require medical intervention within the first months of life. This assessment is a priority in low and medium resource countries. The purpose of this study was to assess the cost-effectiveness (CE) relation of pulse oximetry in the detection of cases of CCHD in Colombia.MethodsA full economic assessment of the cost-effectiveness type was conducted from the perspective of society. A decision tree was constructed to establish a comparison between newborn physical examination plus pulse oximetry, versus physical examination alone, in the diagnosis of CCHDs. The sensitivity and specificity of pulse oximetry were estimated from a systematic review of the literature; to assess resource use, micro-costing analyses and surveys were conducted. The time horizon of the economic evaluation was the first week after birth and until the first year of life. The incremental cost-effectiveness ratio (ICER) was determined and, to control for uncertainty, deterministic and probabilistic sensitivity analysis were made, including the adoption of different scenarios of budgetary impact. All costs are expressed in US dollars from 2017, using the average exchange rate for 2017 [$2,951.15 COP for 1 dollar].ResultsThe costs of pulse oximetry screening plus physical examination were $102; $7 higher than physical examination alone. The effectiveness of pulse oximetry plus the physical examination was 0.93; that is, 0.07 more than the physical examination on its own. The ICER was $100 for pulse oximetry screening; that is, if one wishes to increase 1% the probability of a correct CCHD diagnosis, this amount would have to be invested. A willingness to pay of $26.292 USD (direct medical cost) per probability of a correct CCHD diagnosis was assumed.ConclusionsAt current rates and from the perspective of society, newborn pulse oximetry screening at 24 h in addition to physical examination, and considering a time horizon of 1 week, is a cost-effective strategy in the early diagnosis of CCHDs in Colombia.Trial registration “retrospectively registered”.

Newborn Screening Pulse Oximetry to Detect Critical Congenital Heart Disease: A Follow-Up Survey of Current Practice at Army, Navy and Air Force Hospitals.

The purpose of this study was to assess the evolution of newborn pulse oximetry screening (+POx) among Army, Air Force, and Naval military hospitals (MH), including prevalence, protocol use, quality assurance processes, access to echocardiography, and use of telemedicine. This is a follow-up from a prior study published in 2011. An Internet-based questionnaire was forwarded to the chief pediatrician at MH worldwide which support newborn deliveries. Descriptive data were reported using percentages. Grouped responses, as applicable, were further compared using the chi-square test. A p-value < 0.05 was considered statistically significant. Seventy-eight percent (36/46) of MH supporting deliveries worldwide responded to the survey (17 Army hospitals, 11 Navy Hospitals, 8 Air Force hospitals). All responding hospitals utilize +POx, of which 94% endorsed protocol compliance with the American Academy of Pediatrics guidelines. Nine (25%) hospitals were located outside of the United States. Delivery volumes (infants per month) range between 1-49 (36%), 50-99 (28%), 100-199 (19%), and 200-300 (17%). Eleven hospitals reported regular review of +POx data, with most reviewing them monthly. Four MH share findings with state institutions. Ten hospitals either have a staff pediatric cardiologist or use tele-echocardiography for on-site evaluations. Ten hospitals are located greater than 60 miles from the nearest center with echocardiography capabilities. Of the five hospitals using tele-echocardiography, four confirmed critical congenital heart disease (CCHD) using this practice, and all five reported averting transfer of an infant using this technology. Of the 22 hospitals lacking the ability to obtain on-site echocardiography, 12 (55%) are interested in implementing a tele-echocardiography protocol. All responding MH use +POx, representing significant increase from the 30% of MH reporting use of +POx seven years ago. The majority of MH follow AAP +POx guidelines, and though most have providers review results prior to discharge, only one-third report periodic chart review for quality assurance. Most MH transfer infants with positive +POx results for evaluation due to a lack of on-site echocardiography. Tele-echocardiography was reported as a potential solution to diagnose or rule out CCHD. Over half of remaining hospitals without cardiologists are interested in using this technology to evaluate stable infants with positive CCHD screening.

First-Year Outcomes of Critical Congenital Heart Disease Screening in Maryland.

Objectives. Newborn screening for critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel in 2011, and states have been gradually adding pulse oximetry as point-of-care screening to panels. Few data are available on the effectiveness of pulse oximetry as a mandated screening. This study describes outcomes of the first year of screening in Maryland. Methods. A web-based data collection tool for screening results and outcomes, eScreener Plus, was utilized. Data collected from the start of screening from September 1, 2012, to December 31, 2013, were analyzed. Well-baby nursery data were evaluated separately from neonatal intensive care unit (NICU) data to determine whether setting influenced effectiveness. Results. In the first 15 months of newborn screening for CCHD in Maryland, 4 asymptomatic infants were diagnosed with a critical cardiac condition by newborn screening. Eleven infants passed but were later identified with a primary or secondary target condition. Seventy-one percent of infants with CCHD were identified prenatally or by clinical signs and symptoms. Pulse oximetry screening for CCHD had a specificity of more than 99% in both the well-baby nursery and the NICU. Sensitivity in the well-baby nursery was 10% and 60% in the NICU. Conclusion. Further investigation and interpretation of specific protocols that were used and outcomes of screening is needed for continued refinement of the well-baby algorithm and NICU protocol development. Pulse oximetry screening in newborns provides valuable clinical information, but many infants with CCHD are still not identified with current protocols.

Consumer Satisfaction with Newborn Pulse Oximetry Screening in a Midwifery-Led Maternity Setting.

Pulse oximetry screening to detect hypoxaemia in newborn infants was introduced at birthing facilities in New Zealand during a feasibility study determining barriers and enablers to universal screening in a midwifery-led maternity system focused on community values and partnership with, and participation by, consumers. During the 2-year study period, parents of infants who underwent pulse oximetry screening were invited to complete a written survey to investigate consumer satisfaction. Respondents ranked their satisfaction with the test and with information resources on a five-level Likert scale. Additional comments were added in a free text space. Participation was voluntary and anonymous. A total of 657 surveys were included for analysis. Consumers were satisfied with the screening procedure; 94% either agreed or strongly agreed that it is an important health check. Although the quality of information sources was deemed good, a third of participants indicated a wish to obtain more information. Some participants stated that retention of information was an issue, reporting that they were fatigued following the birth. Consumers are receptive to pulse oximetry screening. Sharing information (while considering the receptivity of parents) and engaging the parents of newborn infants are factors that are paramount to the success of newborn screening initiatives.

Abstract 17294: The Effect of Statewide Electronic Reporting on Pulse Oximetry Screening in Newborns

Background: Pulse oximetry screening (POxS) is used to screen newborns for critical congenital heart disease (CCHD). A pilot study in Minnesota identified missed screens in eligible newborns and incorrect interpretation of the screening algorithm as major barriers in our screening program. To address these issues, the Minnesota Department of Health (MDH) implemented a statewide electronic reporting system for POxS with clinical decision support (MNScreen). MNScreen records individual POxS data at testing and provides real-time clinical decision support at bedside. This system has been utilized in all birth hospitals, birth centers, and by many midwives in Minnesota since January 1, 2017. Objective: Our goal was to determine the impact of MNScreen on missed and misinterpreted POxS in its first year of use. Subsequent work will be aimed at determining if MNScreen improves POxS detection of CCHD. No prior assessment of statewide electronic screening programs has been reported. Methods: Retrospective analysis of the statewide POxS data for all infants born in Minnesota and reported via MNScreen in 2017. MNScreen data was compared to state birth records to assess completeness of screening. Data was analyzed for positive screens and accurate interpretation of POxS algorithm. Results: POxS was performed on 65,018 (96.4%) of eligible newborns in 2017. A positive screen was accurately reported in 124 newborns (0.19%). POxS was misinterpreted at reporting in 284 (0.44%) of newborns, despite clinical decision support. Overall, POxS rates improved when compared to 10.7% of missed screens in the pilot study. The rate of misinterpreted screens remained high in year 1 of MNScreen (0.44% vs 0.29% in pilot). Conclusions: Missed POxS and misinterpretation of POxS algorithms are a major challenge for CCHD screening programs. In the first year of MNScreen, the percentage of newborns screened improved, but the accuracy of algorithm interpretation did not, despite cues from the automated screening software. Real time data transmission allows rapid MDH follow up of at risk newborns. Further work will include identifying strategies to reduce missed screens and making Improvements to the MNScreen software to reflect on-site POxS decision making.

Comment on Kluckow M. Barriers to the Implementation of Newborn Pulse Oximetry Screening: A Different Perspective. Int. J. Neonatal Screen. 2018, 4(1), 4.

We read the review article by Kluckow M (Barriers to the Implementation of Newborn Pulse Oximetry Screening[...]

The impact of altitude on screening for critical congenital heart disease.

The objectives were to determine the frequency with which pulse oximetry identifies critical congenital heart defects in asymptomatic full-term and late preterm newborns using the AAP expert panel algorithm in a variety of different hospital settings and to evaluate the impact of altitude on the rate of positive screens. We conducted a prospective clinical study of implementation of a newborn pulse oximetry screening for congenital heart disease in 34 independent hospitals. Infants were eligible for enrollment if their gestational age was 35-44 weeks. Of the 34 sites which enrolled infants into our study, 24 were located at or below 2000 feet; 5 were located between 4700 and 6000 feet and 5 were located above 6000 feet in altitude. We screened 6109 infants; 65 (1.1%) had a positive screen. There were no differences in median gestational age, birth weight, mode of delivery or race/ethnicity for infants with a positive screen compared to infants with a negative screen. Infants with positive screens were more often male and more often born at sites located at high altitudes. The frequency of a positive screen increased from 0.2% for infants born at sites at or less than 2000 feet to 6% for sites located above 6000 feet. We stopped enrollment at the site located at 8163 feet after enrolling 65 infants because 23 (35%) were positive. Screening infants for critical cardiac defects at altitude is complicated by the increased false positive screens.

Barriers to the Implementation of Newborn Pulse Oximetry Screening: A Different Perspective.

Pulse oximetry screening of the well newborn to assist in the diagnosis of critical congenital heart disease (CCHD) is increasingly being adopted. There are advantages to diagnosing CCHD prior to collapse, particularly if this occurs outside of the hospital setting. The current recommended approach links pulse oximetry screening with the assessment for CCHD. An alternative approach is to document the oxygen saturation as part of a routine set of vital signs in each newborn infant prior to discharge, delinking the measurement of oxygen saturation from assessment for CCHD. This approach, the way that many hospitals which contribute to the Australian New Zealand Neonatal Network (ANZNN) have introduced screening, has the potential benefits of decreasing parental anxiety and expectation, not requiring specific consent, changing the interpretation of false positives and therefore the timing of the test, and removing the pressure to perform an immediate echocardiogram if the test is positive. There are advantages of introducing a formal screening program, including the attainment of adequate funding and a universal approach, but the barriers noted above need to be dealt with and the process of acceptance by a national body as a screening test can take many years.

Pulse oximetry screening in newborns to enhance detection of critical congenital heart disease.

Pulse oximetry screening is safe, noninvasive, easy to perform and proven to enhance detection of critical congenital heart disease in newborns. However, this test has yet to be adopted as routine practice in Canada. The present practice point highlights essential details and recommendations for screening, which research has shown to be highly specific, with low false-positive rates. Optimal screening for critical congenital heart disease should include prenatal ultrasound, physical examination and pulse oximetry screening. Screening should be performed between 24 hours and 36 hours postbirth, using the infant's right hand and either foot to minimize false-positive results. Newborns with abnormal results should undergo a thorough evaluation by the most responsible health care provider. When a cardiac diagnosis cannot be excluded, referral to a paediatric cardiologist for consultation and echocardiogram is advised.

Infants born with critical CHD in Arizona and capacities of birth centres for screening and management

The aims of this study were to identify locations of births in Arizona with critical CHD, as well as to assess the current use of pulse-oximetry screening and capacities of birth centres to manage a positive screen. Study design Infants (n=487) with a potentially critical CHD were identified from the Arizona Department of Health Services from 2012 and 2013; charts were retrospectively reviewed. Diagnosis was confirmed using echocardiographies. ArcGIS was used to generate maps to visualise the location of treating facility and mother's residence. Birth centres were surveyed to assess screening practices and capacities to manage critical CHD in 2015. Of the 272 patients identified with critical CHD, 52% had been diagnosed prenatally. Patients travelled an average distance of 55.1 miles to their treating facility. Mortality was not related to prenatal diagnosis (p=0.30), living at a high elevation (p=0.82), or to distance travelled to the treating facility (p=0.68). Of 50 birth centres, 33 responded to the survey and all centres practiced critical CHD screening. A total of 25 centres could perform paediatric echocardiographies; 64% of these centres could digitally transmit echocardiograms. In all, 24 birth centres maintained access to prostaglandins. Pulse-oximetry screening in newborns is currently implemented in the majority of Arizona hospitals. Although most centres could perform initial management steps following a positive screen, access to paediatric cardiology services was limited. Patients with critical CHD sometimes travelled a great distance to treating facilities. Digital transmission of echocardiograms or tele-echocardiography would reduce the distance travelled for the management of a positive screen, decrease the financial burden of transportation, and expedite care for critically ill neonates.

Congenital Heart Disease.

1. Kriti Puri, MD* 2. Hugh D. Allen, MD* 3. Athar M. Qureshi, MD*,† 1. *Department of Pediatrics, 2. †CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX * Abbreviations: ASD: : atrial septal defect AVSD: : atrioventricular septal defect CHD: : congenital heart disease CHF: : congestive heart failure CoA: : coarctation of the aorta EKG: : electrocardiogram HLHS: : hypoplastic left heart syndrome IAA: : interrupted aortic arch IVC: : inferior vena cava LV: : left ventricle mBTT: : modified Blalock-Taussig-Thomas PAPVD: : partial anomalous pulmonary venous drainage PDA: : patent ductus arteriosus RV: : right ventricle SBE: : subacute bacterial endocarditis TAPVD: : total anomalous pulmonary venous drainage VSD: : ventricular septal defect Congenital heart disease (CHD) is present in about 9 of every 1,000 live-born children. (1)(2)(3)(4)(5) Children with CHD are surviving longer, and better understanding of the long-term complications of CHD is continuously emerging. Hence, it is important to be comfortable with the primary care requirements for these children, including physical manifestations prior to surgery and interventional cardiac catheterizations, as well as those concerning for potential need for reintervention, the latest recommendations for endocarditis prophylaxis, respiratory precautions and immunization considerations, and close monitoring of development and behavior. In this article, we will discuss the common types of cyanotic (“blue”) and acyanotic (“pink”) CHD and the role of the primary care physician in the health care of these children before and after surgery and interventional cardiac catheterizations. After completing this article, readers should be able to: 1. Describe newborn pulse oximetry screening for congenital heart disease (CHD) and clinical features of CHD during the newborn period. 2. Describe the clinical presentations and briefly outline management strategies of infants and children with different types of CHD. 3. Discuss single-ventricle palliation by using hypoplastic left heart syndrome as the model lesion. 4. Describe the evaluation and primary care management factors (including endocarditis prophylaxis, immunizations, and exercise restriction) in children with different types of CHD. Newborns with critical congenital heart disease (CHD) may present with symptoms of cyanosis, congestive heart failure (CHF), poor pedal pulses, or a failed newborn CHD pulse oximetry screen prior to discharge. CHD lesions that are dependent on a patent ductus arteriosus (PDA) to support flow either to the systemic circulation or to the pulmonary circulation …

Indigenous Ethnicity and Low Maternal Education Are Associated with Delayed Diagnosis and Mortality in Infants with Congenital Heart Defects in Panama.

BackgroundThis is the first study in Panama and Central America that has included indigenous populations in an assessment of the association between socioeconomic variables with delayed diagnosis and mortality due to congenital heart defects (CHD).MethodsA retrospective observational study was conducted. A sample calculation was performed and 954 infants born from 2010 to 2014 were randomly selected from clinical records of all Panamanian public health institutions with paediatric cardiologists. Critical CHD was defined according to the defects listed as targets of newborn pulse oximetry screening. Diagnoses were considered delayed when made after the third day of life for the critical CHD and after the twentieth day of life for the non-critical. A logistic regression model was performed to examine the association between socioeconomic variables and delayed diagnosis. A Cox proportional hazards model was used to assess the relationship between socioeconomic features and mortality.ResultsAn increased risk of delayed diagnosis was observed in infants with indigenous ethnicity (AOR, 1.56; 95% CI, 1.03–2.37), low maternal education (AOR, 1.57; 95% CI, 1.09–2.25) and homebirth (AOR, 4.32; 95% CI, 1.63–11.48). Indigenous infants had a higher risk of dying due to CHD (HR, 1.43; 95% CI, 1.03–1.99), as did those with low maternal education (HR, 1.95; 95% CI, 1.45–2.62).ConclusionInequalities in access to health care, conditioned by unfavourable socioeconomic features, may play a key role in delayed diagnosis and mortality of CHD patients. Further studies are required to study the relationship between indigenous ethnicity and these adverse health outcomes.

Newborn pulse oximetry screening in practice

The concept of using pulse oximetry (PO) as a screening test to identify newborn babies with critical congenital heart defects (CCHD) before life-threatening collapse occurs has been debated for some...

Feasibility of Pulse Oximetry Pre-discharge Screening Implementation for detecting Critical Congenital heart Lesions in newborns in a secondary level maternity hospital in the Western Cape, South Africa: The 'POPSICLe' study.

Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world. To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital, a busy government hospital in Cape Town, South Africa. Parent and staff acceptance was assessed. We conducted a prospective study of predischarge POx screening in one postnatal ward, following informed parental consent. During the 4-month study period, 1 017 of 2 256 babies discharged (45.1%) were offered POx screening and 1 001 were screened; 94.0%of tests took &lt;3 minutes to perform, 4.3% 3 - 5 minutes and 1.7% &gt;5 minutes. Eighteen patients needed second screens and three required thirdscreens. Only 3.1% protocol errors were made, all without consequence. The vast majority (91.6%) of nursing staff reported insufficient time toperform the study screening in addition to their daily tasks, but ~75% felt that with a full nursing staff complement and if done routinely (not partof a study), pre-discharge POx screening could be successfully instituted at our facility. Over 98% of the mothers had positive comments. Twobabies failed screening and required echocardiograms; one was diagnosed with CCHD and the other with neonatal sepsis. The sensitivity andspecificity were 50% (95% confidence interval (CI) 1.3 - 98.7%) and 99.9% (95% CI 99.4 - 100%), respectively, with a percentage correct of 99.8%. POx screening was supported and accepted by staff and parents. If there are no nursing staff shortages and if it is doneroutinely before discharge, not as part of a study, we conclude that POx screening could be implemented successfully without excessive falsepositives or errors, or any additional burden to cardiology services.

Abstract 11174: A Novel Approach to Critical Congenital Heart Disease (CCHD) Screening at Moderate Altitude

Introduction: Prenatal studies and postnatal physical exam leave 13- 55% of neonates with CCHD undiagnosed leading to presentation in extremis or death. The AHA has endorsed newborn pulse oximetry screening to capture these infants prior to hospital discharge. Moderate altitude can impart higher screening failure rates. We therefore evaluated a modified CCHD screening protocol in an attempt to reduce false positive screenings at a moderate altitude of 6200 feet (1890 m). Methods: We prospectively enlisted well newborn infants greater than 35 weeks. Near 24 hours of life, trained nursing staff performed pulse oximetry on the right hand and either foot. Those with saturations ≤95% with &lt; 3% difference between hand and foot measurements passed. Infants with saturations &lt;86% failed. Infants with saturations between 86-94% or &gt;3% difference in saturations were placed in an oxygen hood with FiO2 designed to replicate sea level atmospheric oxygen tension for 20 minutes to accelerate neonatal transition. These infants were tested again up to 2 additional screens in room air with standard sea level protocol. Providers were notified and echocardiograms ordered for all infants deemed to have failed. Results: A total of 2005 infants completed the protocol. The failure rate was 0.3% (7/2005), which was not different from the sea level rate of 0.2%. Sea level CCHD screening criteria would have given a failure rate of 0.75%. An additional 2.1% (42/2005) had incomplete screening and were not passing at the time the test was stopped. We found 5/7 (71.4%) infants failed secondary to low saturations, 1/7 (14.3%) failed secondary differential saturations, and 1 infant failed for multiple reasons. Three of the seven infants with failing screens were discharged prior to echocardiogram. None of the infants receiving echocardiograms had critical congenital heart disease. Conclusions: We found a failure rate of 0.3% using an alternate algorithm adjusted for altitude. This failure rate approximates the overall screening failures reported at sea level and is significantly lower than prior reports at altitude. Additional research is needed specifically addressing sensitivity and positive predictive value for screening at moderate altitudes.

Pulse oximetry screening of newborns: not just a screening test for congenital heart disease.

Pulse oximetry screening of newborns: not just a screening test for congenital heart disease.

Newborn pulse oximetry screening

Newborn pulse oximetry screening

Pulse oximetry screening of newborns: Not only a screening test for congenital heart disease.

Pulse oximetry screening of newborns: Not only a screening test for congenital heart disease.