Newborn Pulse Oximetry Screening Research Articles

The Performance of Critical Congenital Heart Disease Screening in Rural Versus Urban Locations in the Northwest United States

Pulse oximetry screening of newborns detects critical congenital heart disease (CCHD). Rural birth location is known to affect timing and management of when infants with CHD undergo surgery, but its association with CCHD screening is unknown. We assess the relationship between rural location and postnatal CCHD diagnosis and describe lesion-specific modes of diagnosis. Data were abstracted from medical records at 2 cardiac surgery centers in Washington state. Infants with CCHD, defined as CHD requiring either cardiac intervention or resulting in death at <1month of age, born between July 2015 and June 2020, were included and classified by method of identification. Patient home ZIP codes were used to determine rural location. We included 561 newborns with CCHD; 35% were diagnosed postnatally. Predominant postnatal mechanisms of identification (n=194) included symptomatic before CCHD screening period (56%), CCHD screening (22%), and symptomatic after false-negative screen (15%). Postnatal diagnosis rate increased with degree of ruralness (48% in small rural/isolated regions vs 32% in urban regions; P=.01) and incidence of undiagnosed CCHD at birth increased with lower nursery levels (5.5/10000 live births in nursery level 1 vs 2.1/10000 live births in level 4). CCHD screening identifies 22% of postnatally diagnosed CCHD and 7% of cases overall in our region. Postnatal diagnosis is more common in rural regions. The incidence of undiagnosed CCHD at birth increases with decreasing nursery levels. This study supports the value of CCHD screening in routine newborn care, especially in rural areas and hospitals with lower nursery levels.

Newborn pulse oximetry screening: time for equity in the UK?

Newborn pulse oximetry screening: time for equity in the UK?

Newborn Pulse Oximetry Screening for Detecting Congenital Heart Disease: Experience at a Tertiary Care Center.

Congenital heart disease (CHD) remains the number one birth defect worldwide. Pulse oximetry screening (POS) is a widely used CHD screening modality effective in detecting critical lesions. This study is aimed at assessing the accuracy and cost-effectiveness of POS in a cohort of term well-babies admitted to a regular nursery in a tertiary care center. We reviewed the charts of term babies admitted to our regular nursery over a period of one year. The results of POS and the findings of echocardiography were collected. Similarly, we explored the records of our fetal echocardiography program to identify the fetuses screened for CHD during the same period. 900 term babies were born and admitted to newborn nursery at our center, and 69 fetuses were evaluated by our fetal cardiology team during the study period. None of our term babies had a positive POS at birth or 24 hours of age. However, 56 babies had a cardiac echo before hospital discharge due to suspicious findings on physical examination or a family history of CHD. A simple noncritical CHD was noted in 10 of them. Additionally, 53 babies underwent echocardiography within the first five years of life; a simple CHD was noted in 6 of them. In parallel, 21 of our fetuses were found to have CHD: 16 simple CHD and 5 critical CHD (CCHD). Despite its cost-effectiveness and efficacy in screening for CCHD, POS is suboptimal for detecting simple CHD. In the absence of a proper prenatal screening and fetal echocardiography program, POS remains a cost-effective modality for detecting CCHD.

Rethinking Pulse Oximetry Screening in the Level-IV Neonatal Intensive Care Unit.

This study aimed to evaluate the outcomes of newborn pulse oximetry screening in a level IV, tertiary care neonatal intensive care unit (NICU). This is a retrospective cohort study of neonates who received newborn pulse oximetry screening after being admitted to a single-center, level-IV NICU between 2014 and 2021. Neonates with known critical congenital heart disease were excluded from the study. Of the 4,493 neonates who had pulse oximetry screening, there were three positive screens (fail rate of 0.067%, 0.67 per 1,000 screened). The average age of screening was 818 hours. There were no positive screens of newborns who were admitted during their initial birth hospitalization and were screened while off oxygen. There were no new diagnoses of critical congenital heart disease (true positives) and there were no known false negatives. The results bring into question whether pulse oximetry screening with the current AAP-endorsed algorithm should be re-evaluated for a level-IV NICU at a children's hospital. However, the results may not be generalizable to other NICU's where echocardiography and prenatal echocardiograms are not as readily available. · Pulse oximetry has been shown to be effective in decreasing delayed diagnosis of critical congenital heart disease (CCHD); however, there are limited prior studies on newborn pulse oximetry in the NICU.. · In our study of over 4,000 neonates admitted to a level IV tertiary care NICU, there were no true positives (no new diagnoses of CCHD).. · Special considerations may be needed for pulse oximetry screening in the NICU setting..

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Screening of Newborn by Pulse Oximetry at Birth for the Critical Congenital Heart Disease

Background: Early diagnosis of congenital heart disease is important for a good clinical outcome. Unrecognized or delayed diagnosis of some severe congenital heart diseases can lead to cardiac failure, cardiovascular collapse, and even death. Pulse oximetry screening (POS) in newborns has been shown to enhance the detection of critical congenital heart disease (CCHD). Clinical evaluation is likely to miss the diagnosis in first few hours of hospital stay after birth due to absence of signs and symptoms of CCHD. In the absence of clinical findings during early neonatal period, the best parameter that can be assessed, is the detection of hypoxemia by pulse oximetry screening. Aims and Objectives: Usefulness of pulse oximetry in newborn for early detection of Critical Congenital Heart Disease (CCHD). Material and Methods: This Prospective Observational Study was conducted on 125 newborn babies in postnatal ward at tertiary care centre for a period of 2 years satisfying the inclusion and exclusion criteria. Evaluation was done between 24 to 48 hours of birth with pulse oximeter. Institutional ethics committee permission was taken prior to study. Results and Conclusion: Total 125 neonates were screened by pulse oximeter, 2 were detected to have positive screen for Congenital Heart Disease (CHD) of which 1 had CCHD confirmed by echocardiography. Study revealed that Pulse Oximetry screening can be an important screening tool in routine neonatal care for early detection of CCHD.

Diagnosis of Coarctation of the Aorta From Infancy to Adulthood

Diagnosis of Coarctation of the Aorta From Infancy to Adulthood

Utility of pulse-oximetry screening in newborns with nonductus-dependent cyanotic congenital heart defects: A reason to alarm?

ABSTRACTObjectives:We aimed to compare the performance of pulse-oximetry screening in detecting nonductus-dependent cyanotic congenital heart defects (CCHDs).Methods:In a prospective cross-sectional study, we recorded post ductal saturation of neonates (<48 h old) born at a community hospital in northern India. Subsequently, all underwent clinical examination and echocardiogram by a trained cardiologist. A saturation <95% was considered a “failed” screen.Results:Ten neonates were identified to have nonductus-dependent CCHD on echocardiogram, five of whom had passed pulse-oximetry screen. This translated to a sensitivity of 50% (95% confidence interval [CI] 23.7%–76.3%) and a positive predictive value of 0.08 (95% CI 0.03–0.2), both of which were significantly less compared to that in ductus-dependent congenital heart defect.Conclusions:Up to half of the nonductus-dependent CCHD may be missed if screened only using pulse oximetry. Parents should not be reassured regarding the absence of CCHD only based on a “pass” in pulse-oximetry screening.

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Newborn Pulse Oximetry for Infants Born Out-of-Hospital.

Conventional timing of newborn pulse oximetry screening is not ideal for infants born out-of-hospital. We implemented a newborn pulse oximetry screen to align with typical midwifery care and measure its efficacy at detecting critical congenital heart disease. Cohort study of expectant mothers and infants mainly from the Amish and Mennonite (Plain) communities with limited prenatal ultrasound use. Newborns were screened at 1 to 4 hours of life ("early screen") and 24 to 48 hours of life ("late screen"). Newborns were followed up to 6 weeks after delivery to report outcomes. Early screen, late screen, and combined results were analyzed on the basis of strict algorithm interpretation ("algorithm") and the midwife's interpretation in the field ("field") because these did not correspond in all cases. Pulse oximetry screening in 3019 newborns (85% Plain; 50% male; 43% with a prenatal ultrasound) detected critical congenital heart disease in 3 infants. Sensitivity of combined early and late screen was 66.7% (95% confidence interval [CI] 9.4% to 99.2%) for algorithm interpretation and 100% (95% CI 29.2% to 100%) for field interpretation. Positive predictive value was similar for the field interpretation (8.8%; 95% CI 1.9% to 23.7%) and algorithm interpretation (5.4%; 95% CI 0.7% to 18.2%). False-positive rates were ≤1.2% for both algorithm and field interpretations. Other pathologies (noncritical congenital heart disease, pulmonary issues, or infection) were reported in 12 of the false-positive cases. Newborn pulse oximetry can be adapted to the out-of-hospital setting without compromising sensitivity or prohibitively increasing false-positive rates.

Newborn Pulse Oximetry Screening at a Community Hospital: An 8-Year Experience.

To evaluate newborn pulse oximetry screening (POS) outcomes at a large community hospital and the impact of the recommended revised POS algorithm. A retrospective cohort study was performed to evaluate the results of POS in the well-infant nursery between 2012 and 2020. The POS results were obtained from an electronic platform. Chart review was completed for newborns with failed screens. The recommended revision to POS, no second rescreen, was applied to the data to evaluate screening outcomes. Of the total 65 414 infants admitted to the well-infant nursery during this 8-year period, >99% (n = 64 780) received POS. Thirty-one infants failed POS (4.6 per 10 000 screened). All infants who failed POS were found to have a disorder, with 12 (39%) having critical congenital heart disease (CCHD), 9 (29%) having non-CCHD requiring further follow-up, and 10 (32%) having noncardiac conditions. One false-negative screen result was identified through the Maryland Department of Health Newborn Screening Follow-up Program. The positive predictive value of POS for those screened was 39% for CCHD, with a specificity of 99.97%. Eliminating the second rescreen in the POS algorithm would have resulted in an additional 5 newborns without CCHD failing POS, increasing the false-positive rate from 0.03% to 0.04%. POS is an effective tool for identifying CCHD and secondary conditions. POS was successfully implemented with few missed screens and was highly specific. Elimination of the second rescreen in the pulse oximetry algorithm would have resulted in a minimal increase in false-positive results and faster evaluation of newborns with CCHD.

Pulse Oximetry Screening and Critical Congenital Heart Disease in the State of Oregon.

Late diagnosis of critical congenital heart disease (CCHD) is associated with higher levels of morbidity and mortality in neonates. Nearly all states have passed laws mandating universal pulse oximetry screening (POxS) of newborns to improve early detection rates of CCHD. We performed a retrospective chart review of all transthoracic echocardiograms (TTEs) interpreted by our institution on patients between 0 and 30 days of life in the years 2010 (prior to POxS) and 2015 (after POxS). Between 2010 and 2015, the number of neonatal TTEs interpreted by our institution decreased by 18.2%. In 2015, there were 46 neonates diagnosed with CCHD with a 78% prenatal detection rate. There was only one case of a true-positive POxS. Our study demonstrated that the initiation of POxS coincided with a significant decrease in neonatal TTEs, suggesting universal POxS may impart reassurance to primary providers leading to a decrease in TTE utilization.

Early detection of significant congenital heart disease: The contribution of fetal cardiac ultrasound and newborn pulse oximetry screening.

Fetal cardiac and newborn pulse oximetry screening has greatly facilitated the detection of cardiac abnormalities, which may be serious with potentially dire neonatal consequences. The prenatal diagnosis of a serious cardiac abnormality allows the attending obstetrician to organise the much safer in-utero transfer of the fetus for delivery at a tertiary centre, particularly if there is evidence of a duct-dependent lesion that may require the infusion of Prostaglandin E1 to maintain duct patency pending surgical intervention. Newborn pulse oximetry alerts the paediatrician that the baby may have a significant cardiac abnormality, which warrants further elucidation prior to discharge, rather than for the baby to represent unwell a few days later. Despite these advances, serious cardiac abnormalities may be missed on screening. Their detection then falls back onto the clinical acumen of the attending paediatrician/family physician to review the history, carefully elicit and evaluate the clinical signs further aided by whatever investigations that may be available at the birthing hospital, frequently less resourced than the tertiary centres. At the outset, a brief synopsis is provided of the clinical findings that may point to a cardiac abnormality. That is followed by a critical review of the accuracy of prenatal and newborn pulse oximetry screening with emphasis on the lesions that may be missed. Suggestions are made as to how to improve the diagnostic accuracy.

Abstract 13617: Newborn Critical Congenital Heart Disease Screening Fails to Detect Target Lesions or Reduce Mortality

Introduction: Congenital heart disease (CHD) affects over one million children in the United States. Studies show mixed outcomes regarding a survival benefit from newborn cardiac screening (NCS). California began a NCS program on 7/1/13. We evaluated the effect of mandatory NCS on surgical outcomes of our program. Hypothesis: Neonates with critical CHD (CCHD), requiring surgery as infants, who are not diagnosed prior to or at the NCS have lower survival than those diagnosed prior to or at the NCS. Methods: We evaluated all infants with CCDH undergoing cardiac surgery at our center between 07/01/13 - 12/31/18. Subjects were stratified by timing of diagnosis (pre-screen, screen positive, screen negative). Sensitivity to detect specific lesions was calculated. Primary end-points were operative mortality, absolute mortality, and actuarial survival. Results: Two-hundred-seventy-four infants with CCHD were included. Seventy-nine percent were diagnosed prior to screening, while 8% were diagnosed by NCS, and 13% were screen negative. Total anomalous pulmonary venous return (TAPVR) (47%) and aortic coarctation (CoA) (40%) were the most likely to be undiagnosed at time of NCS (p&lt;0.001). Sensitivity to detect target lesions was 38% overall [TAPVR 73%, CoA 12%, hypoplastic left heart syndrome (HLHS) 25%, Tetralogy of Fallot (TOF) 29%]. Primary end-points were not different based on timing of diagnosis (p&gt;0.05) (Figure). Conclusions: We found only a 38% sensitivity of mandatory newborn CCHD screening to detect target cardiac lesions requiring surgery in the first year of life. A high proportion of newborns with HLHS, TOF, and CoA remained undiagnosed after screening, though TAPVR was readily detected. There were no differences in survival between the screening groups. Mandatory newborn CCHD pulse oximetry screening can detect some newborns with critical heart disease, but should not replace traditional methods of monitoring in the fetal, newborn, and infant periods.

Recommended Changes to Critical Congenital Heart Disease Screening by Pulse Oximetry in Newborns

In 2011, an algorithm for pulse oximetry screening in newborns to detect critical congenital heart disease was published and subsequently endorsed by

Acceptability of newborn pulse oximetry screening

Aim The aim of this study was to determine the acceptance of the midwives regarding the use of newborn pulse oximetry screening (NPOS) over a four-year period in a UK tertiary maternity unit. Methods An electronic survey of 10 questions was emailed to all midwives working in the maternity unit. Feedback was requested on their experience of performing NPOS using a feasibility scale (1=easy to 10=difficult). Other qualitative feedback explored the perceived usefulness and recollection of positive screening outcomes. The collated feedback was analysed using Wilcoxon Signed Rank test. Results Complete responses were received from 99 of 236 (42%) midwives. The average scale rankings of 3.46 (pre-introduction) and 2.38 (post-introduction) indicates that the responding midwives were positive about NPOS (z=-4.5575; p&lt;0.001) and 99% (n=98) felt it was an important screening tool. Of the midwives, 38 (39%) had at least one positive screening result. Conditions identified included cardiac anomalies, sepsis and diaphragmatic hernia. Conclusion Our single-centre survey suggests that the NPOS has been well accepted by the midwifery staff in this maternity unit.

Role of pulse oximetry as a screening tool for detection of critical congenital heart diseases in newborns in Southern India

Background: Timely diagnosis of critical congenital heart disease (CrCHD) is challenging but critical. Although echocardiography is the gold standard for diagnosis of CrCHD, it cannot be used as a screening tool. Pulse oximetry is a non-invasive, cost-effective screening tool, which can be used to detect CrCHDs in newborns. Objective: The main objective of the study was to assess the usefulness of pulse oximetry as a screening tool for early detection of CrCHD in otherwise asymptomatic newborns. Materials and Methods: This study was a hospital-based prospective observational study carried out at the Department of Paediatrics at a Tertiary Hospital of Southern India over a period of 12 months from January 2016 to December 2016. A total of 1000 asymptomatic newborns of &gt;35 weeks of gestation born in the hospital were enrolled in the study. The screening was considered positive if pulse oximetry saturation (SpO2) &lt;90% in right hand (RH) or foot (F) or three readings of SpO2 of 90–94% in RH and F or &gt;3% SpO2 difference between RH and F at three readings. Echocardiography was performed in those with clinical suspicion of CHD and/or positive pulse oximetry screening. Results: In the present study, the sensitivity of pulse oximetry for detection of CrCHD was 100% and specificity was 98.5%. Conclusion: Pulse oximetry screening is an effective and reliable test which significantly increases the detection rate of CrCHDs compared to the current practice of clinical examination alone as a screening tool. This study reinforces the importance of pulse oximetry screening in newborns.

Health professionals’ views of newborn pulse oximetry screening in a midwifery-led maternity setting. “It's a good thing to do, but fund it!”

ObjectiveTo understand from health professionals who care for newborns their views on the introduction of pulse oximetry screening for the detection of hypoxaemia in a midwifery-led maternity setting. Although oximetry screening for newborns is internationally accepted, national screening is not yet introduced in New Zealand. In this context, we drew on maternity carers’ reflections during a feasibility study of oximetry screening to provide perspectives on barriers and enablers to universal screening. MethodsData were generated from nine focus groups during five months of 2018 in two north island regions of New Zealand. Participants’ (n = 45) opinions about the use of oximetry screening in newborns were analysed thematically using an inductive approach. FindingsOverall, participants stated pulse oximetry screening was easy to do, non-invasive, and worthwhile. Midwives were reassured by screening that provided evidence of either a healthy baby or a need for urgent review. From participants’ reports, we identified three themes: (1) oximetry screening for newborns is reassuring, practical and worthwhile; (2) midwifery services workload expectations and under-resourcing will hinder universal screening, and (3) location of the baby at the time of screening could impede universal access. Conclusion and implications for practiceMidwives viewed implementing a national pulse oximetry screening programme as sensible but problematic unless resourced and funded appropriately. Policymakers should view the concerns of midwives about human and physical resources as significant and account for the need to resource this screening programme appropriately as a priority before implementation.

Detecting Critical Congenital Heart Disease in Nevada.

We reviewed data on patients born with critical congenital heart disease in the state of Nevada and analyzed detection via prenatal diagnosis versus newborn pulse oximetry screening, location of birth, and gestational age at birth. We inquired our databases and electronic health records for all patients with critical congenital heart disease born in Nevada between January 2016 and May 2019. We identified 218 live born patients. Of the 218, average gestational age was 38 weeks (±2.2 weeks). Of the 218, 171 (78%) were prenatally diagnosed, 37 (17%) were diagnosed by immediate postnatal signs and symptoms, 8 (4%) had false-negative pulse oximetry screens that resulted in post-hospital discharge presentations, and 2 (1%) had positive pulse oximetry screens. The eight post-hospital discharge presentations included four in extremis, two with extreme cyanosis, and two dying at home. Of the 171 prenatally diagnosed patients, 157 (92%) were born at the Nevada hospital with the congenital cardiac unit. To the best of our knowledge, our results represent the highest statewide, general population prenatal detection of critical congenital heart disease in the United States. Our high prenatal detection rate led to the majority of patients being born at the Nevada facility with the congenital heart unit, limiting intrastate neonatal transports. On average, patients were born at term. Further, in Nevada, state-mandated, universal pulse oximetry screening resulted in more false-negative results than positive results.

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease.

AimAssess the potential additional benefit from pulse oximetry screening in the early detection of critical congenital heart disease in a country with a well‐developed antenatal ultrasound screening programme.MethodsLive‐born infants, pregnancy terminations and stillbirths from 20 weeks’ gestational age, between 2013 and 2015, with critical cardiac defects defined as primary or secondary targets of pulse oximetry screening were identified. Critical defects were those resulting in the death of a fetus or an infant in the first 28 days after birth, or a defect requiring intervention in the first 28 days.ResultsTwo hundred and sixty‐eight infants and Fetuses were identified. Antenatal detection rates improved from 69% to 77% over the study period. An associated co‐morbidity improved antenatal detection rates. Twenty‐seven live‐born infants were diagnosed after discharge: 15 aortic arch obstruction (AAO); 10 d‐loop transposition of the great arteries (d‐TGA), and two total anomalous pulmonary venous drainage (TAPVD). Of these, five with AAO, nine with d‐TGA and likely both with TAPVD could potentially have been detected with oximetry screening.ConclusionThe antenatal detection of critical cardiac anomalies continues to improve in New Zealand. Despite high antenatal detection rates for most lesions, universal postnatal oximetry screening has the potential to improve early detection.