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Pulse Oximetry Screening For Critical Congenital Heart Defects: a Repeat UK National Survey

Presented at the Neonatal Society 2017 Spring Meeting.

Mikrou P1, Singh A1, Ewer AK1,2

1 Neonatal Intensive Care Unit, Birmingham Women’s Hospital, Birmingham, UK
2 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

Background: Pulse oximetry (PO) is a simple, safe and reproducible screening tool that identifies critical congenital heart defects missed by existing screening methods (1,2). PO has been incorporated into the national screening programme of some countries (including the USA in 2011) while the debate whether it should be part of the national screening programme in the UK continues. In 2012 only 18% of UK units used PO screening (3). We aimed to assess how practice has changed over the last 4 years.

Methods: Lead clinicians from all 193 neonatal units in the UK were contacted by email (with telephone follow-up for nonresponders) and invited to complete a short online survey.

Results: All 193 UK neonatal units responded. PO screening was performed in 78/193 neonatal units (40%, compared to 18% in 2012). Uptake of PO screening was more likely in level 3 units (50%) compared to level 1 and 2 units (38% and 34% respectively) and there was evidence of regional variation: Wales and the North West of England had the highest uptake (75% and 73% respectively) and the South West of England had the lowest (11%). The majority of screening units (72%) used pre- and post-ductal saturations although there was wide variation in the cut-off for a positive result and only 33% reported using the PulseOx algorithm1 limits (<95% in either limb and/or difference >=3%). Of the 115 units that did not perform PO screening, 12 were in the process of starting and 75 of the remaining units (73%) expressed an interest in adopting the practice. The most commonly perceived obstacles were similar to the previous survey: staffing issues (51%), cost (28%), availability of echocardiography (23%) and concerns regarding false positives (12%). Nineteen per cent of units are waiting a national recommendation.

Conclusion: The UK National Screening Committee is currently considering the possibility of introducing PO screening as national policy. In the meantime practice across the UK appears to be changing with more neonatal units adopting or willing to adopt PO as a routine screening tool. There is still significant variation in the protocols used. This may be resolved by a national recommendation.

Corresponding author: voulamik@doctors.org.uk

References
1. Ewer AK, et al. Pulse oximetry as a screening test for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet 2011:378: 85–94.
2. 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.
3. Singh A, Ewer AK. Pulse oximetry screening for critical congenital heart defects: a UK national survey. Lancet 2013, 381(9866): 53.

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