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National pulse oximetry screening pilot study: feasibility and impact on neonatal services

Presented at the Neonatal Society 2016 Summer Meeting.

Cawsey MJ1, Evans C2, Walker J2, Ewer AK1,3 on behalf of National Pulse Oximetry Screening Pilot Board

1 Neonatal Unit, Birmingham Women’s Hospital NHS Foundation Trust
2 NHS Newborn and Infant Physical Examination Screening Programme, Public Health England
3 Institute of Metabolism and Systems Research, University of Birmingham

Background: The use of pulse oximetry (PO) screening to detect newborn babies with critical congenital heart defects (CCHD) and other hypoxaemic conditions is being considered worldwide. The aim of the Newborn Pulse Oximetry Screening Pilot, mandated by the UK National Screening Committee, was to evaluate the impact of implementing PO screening on NHS services.

Methods: 15 acute Trusts were recruited, 8 were introducing PO screening and 7 were already carrying out PO screening with local protocols. A national pilot screening pathway was developed and implemented across all Trusts. Oximeters were provided and screening commenced in July 2015 continuing for 6 months. Data were collected on all screened babies via the NIPE SMART and EPIC systems. Test positive (TP) babies were identified and further data collection was undertaken. A post-Pilot questionnaire was carried out with representatives of each Trust to assess staff satisfaction and overall feasibility of implementation.

Results: 36 315 babies born during the pilot period were eligible for screening and 32 836 (90%) had a completed screen. 239 were test positive (TP) and 114 (48%) TP babies were admitted to NNU. 90 babies had serious illness, eight of which were cases of undiagnosed CCHD. The other diagnoses in babies admitted reflected common causes of newborn hypoxaemia, including congenital pneumonia and early-onset sepsis. Only 22 admitted babies were healthy. Overall, 52% of babies were screened within the recommended time of 4-8 hrs, but 78% were screened within 12 hrs and 91% within 24 hrs. 104 babies had at least 1 investigation, and 31 had echocardiograms. 10 babies needed to be transferred to another hospital. Overall the Trusts were generally positive about PO screening although five found screening within 4-8 hours challenging.

Conclusion: Standardised screening was successfully introduced into all Trusts and over 90% of eligible babies were screened. The overall TP rate was similar to previous published studies1,2 and the admitted babies had a similar spectrum of disease. TP babies were managed within existing neonatal services. All Trusts decided to continue screening following the conclusion of the pilot with no additional expenditure required.

Corresponding author: matt.cawsey@nhs.net

References
1. Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects (CCHD) in asymptomatic newborns: a systematic review and meta-analysis. Lancet 2012;379:2459-2464.
2. Singh AS, Rasiah SV, Ewer AK. The impact of routine pre-discharge pulse oximetry screening in a regional neonatal unit. Arch Dis Child Fetal and Neonatal Ed 2014; 99:F297-F302.

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