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Feasibility of Pulse Oximetry Screening for Critical Congenital Heart Defects in Homebirths

Presented at the Neonatal Society 2015 Summer Meeting.

Cawsey MJ1, Noble S1, Cross-Sudworth F1, Ewer AK1,2

1 Birmingham Women’s Hospital NHS Foundation Trust, Edgbaston, Birmingham, UK
2 School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK

Background: Congenital heart defects (CHD) are the most prevalent congenital anomaly and an important cause of neonatal mortality and morbidity. Less than 50% of defects are diagnosed antenatally and NIPE examination also misses up to 50%. Pulse oximetry screening is a safe and effective test for the early identification of critical CHD (1). Since 2008 we have screened all asymptomatic inborn babies at BWH and this was rolled out to include all home births from 1/1/14. We hypothesised that carrying out the screen at 2 hours of age in babies born at home is feasible and would not result in a large number of false positive tests.

Methods: We undertook a retrospective analysis of all of the pulse oximetry tests carried out on homebirths between 1/1/14 and 12/5/15 by interrogating the maternity electronic data system. We recorded the total number of babies screened and then carried out a separate analysis of those babies with a positive screen and those babies admitted from the Community for other reasons, using the Badgernet system. We also assessed acceptability of pulse oximetry screening among senior midwives from the homecare team.

Results: Ninety babies were delivered at home during the study period and 80 were screened with Pulse Oximetry. Data from 10 babies was not on the electronic system. There were two positive screens (2.2% of the total) and two babies who required retesting in line with our protocol and had normal saturations after retesting. Both of the positive screens were admitted to NNU with a significant respiratory illness. Three babies who had passed pulse oximetry screening were subsequently admitted to hospital after becoming symptomatic. Two of these babies had a self-limiting problem and one baby was diagnosed with meningitis. No baby was diagnosed with CCHD during the study period. Screening was acceptable to midwives, was reassuring to both staff and parents and did not increase workload.

Conclusion: Pulse oximetry screening as part of routine homebirth care at 2 hours of age is feasible and reassuring to both midwives and parents. Screening identified two babies with significant respiratory illness which required admission to hospital.

Corresponding author: Matt.Cawsey@bwnft.nhs.uk

1. Ewer AK, Furmston AT, Middleton LJ, et al. Pulse Oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technology Assessment. 2012; 16(2), 1366-5278.

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