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The impact of pre-discharge pulse oximetry screening in a regional neonatal unit

Presented at the Neonatal Society 2012 Spring Meeting.

Singh A1, Rasiah SV1, Ewer AK1,2

1 Neonatal Unit, Birmingham Women’s Hospital Foundation Trust, Birmingham, UK
2 University of Birmingham, UK

Background: The PulseOx study (1) assessed the accuracy of pulse oximetry as a screening tool for congenital heart defects (CHD) and was carried out in six hospitals in the West Midlands in 2008. We provided routine predischarge pulse oximetry screening in our regional maternity unit for all postnatal ward babies ≥ 35 weeks gestation.

Methods: We retrospectively reviewed all unexpected admissions to the neonatal unit over a one year period between April ‘10 to March ‘11, specifically examining indication for admission, clinical diagnosis, management and outcome.

Results: There were 462 unexpected admissions to the neonatal unit and 58 babies (12.5%) were admitted for failed pulse oximetry. Diagnosis in babies admitted for failed pulse oximetry included: 2 Critical CHD, 1 Serious CHD, 2 significant CHD, 15 congenital pneumonia, 9 sepsis, 4 pulmonary hypertension, 3 meconium aspiration syndrome, 5 transient tachypnoea of newborn requiring oxygen and 1 metabolic condition. 16 babies (27%) had transitional circulation requiring no treatment. During the study period no baby collapsed acutely on the postnatal wards. 20 echocardiograms were performed for failed pulse oximetry and 9/20 (45%) were abnormal.

Conclusion: Routine use of Pulse oximetry identifies babies with illnesses, which if not identified early could potentially lead to postnatal collapse. It leads to a modest increase in the number of echocardiograms performed.

Corresponding author: anju2270@doctors.org.uk

References
1. Ewer AK, et al. Pulse oximetry as a screening test for congenital heart defects in newborn infants: the PulseOx test accuracy study. Lancet. 2011 Aug 27;378 (9793):785-94

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