Presented at the Neonatal Society 2013 Spring Meeting.
Singh A, Rasiah SV, Ewer A
Birmingham Women’s Hospital, Mindelsohn Way Edgbaston, Birmingham, West Midlands, B15 2
Background: A recent systematic review showed that Pulse oximetry is highly specific for detection of critical congenital heart defects with moderate sensitivity that meets criteria for universal screening. Aims: We conducted a UK national survey to see the opinion regarding pulse oximetry screening. We also looked at the impact of pulse oximetry screening on our regional neonatal unit.
Methods: The survey was conducted by sending a questionnaire via electronic mails to the unit lead clinicians. We retrospectively reviewed all unexpected admissions to the neonatal unit over a two year period, specifically examining indication for admission, clinical diagnosis, management and outcome.
Results: 204/ 204 (100%) Units responded to the survey. Routine screening was done in 36 (18%) units. 8 units were in the process of introducing routine screening. 111 (70%) units were considering routine screening. Commonest concerns regarding pulse oximetry screening were resource issues, lack of national and local guidelines, excess false positives, delayed discharge and cross infection. There were 1021 unexpected admissions to our regional neonatal unit and 123 babies (12%) were admitted for failed pulse oximetry. Diagnosis in babies admitted for failed pulse oximetry included: 8 significant congenital heart disease, 33 congenital pneumonia, 17 sepsis, 8 pulmonary hypertension and 28 other significant conditions. 29 babies had transitional circulation. During the study period no baby collapsed on the postnatal wards. 39 echocardiograms were performed for failed pulse oximetry and 16 were abnormal.
Conclusion: There is a shift of opinion of among UK Neonatologists regarding pulse oximetry screening with a significant majority now in favour, albeit with some reservations. 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: anjusingh@nhs.net
References
1. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Shakila Thangaratinam, Kiritrea Brown, Javier Zamora, Khalid S Khan, Andrew K Ewer. Lancet. 2012 Jun 30;379(9835):2459-64.