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Pulse Oximetry as a Screening Tool to Detect Hypoxia Associated With Early-Onset Sepsis in Asymptomatic Newborns: A Feasibility Study in a Low-Income Country

Presented at the Neonatal Society 2013 Autumn Meeting.

King EM1, Lieu C2, Kasasa A3, Thangaratinam S4,5, Ewer AK1,6

1 School of Medicine and Dentistry, University of Birmingham
2 ELLY (East London and International Women’s Health Appeal), Barts Charity, Barts Health NHS Trust
3 Saint Francis Referral Hospital, Ifakara, Tanzania
4 Women’s Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London
5 Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine, Queen Mary University of London
6 Birmingham Women’s Healthcare NHS Foundation Trust

Background: Neonatal sepsis is often missed in the developing world, contributing to increased morbidity and mortality. Pulse oximetry used to screen asymptomatic newborns infants for congenital heart disease also frequently identifies cases of sepsis (1). Aims: i) To assess the feasibility of using pulse oximetry as a screening tool in low-income countries to detect hypoxemia associated with early-onset sepsis in asymptomatic newborns. ii) To evaluate the acceptability of pulse oximetry screening to mothers and healthcare professionals.

Methods: Study design: Prospective cohort study. Place and Duration of Study: Saint Francis Referral Hospital, Ifakara, Tanzania between January and March 2013. Methodology: All eligible asymptomatic newborns of more than 33 weeks gestational age born during the study period were screened on two occasions using pulse oximetry. Newborns with oxygen saturations below predefined thresholds were test positive. We recorded the proportion of eligible newborns screened, time taken for the test and the acceptability of pulse oximetry use to mothers and healthcare professionals. The rates of hypoxaemia and clinical diagnosis of sepsis in asymptomatic newborns were evaluated. Ethical approval was gained from the University of Birmingham and St Francis referral hospital and funding was provided by the Arthur Thompson Trust.

Results: A total of 316 asymptomatic newborns were screened, of which eighteen (5.7%) were classified as test positive. Clinical examination led to the diagnosis of sepsis in 41 newborns (13%), including eight newborns who tested positive with pulse oximetry screening. Mothers (n=50) and healthcare professionals (n=18) were predominantly satisfied with screening.

Conclusion: It is feasible to evaluate the role of pulse oximetry as a screening tool to detect early-onset sepsis in a low-income setting. The test is acceptable to mothers and healthcare professionals. Further studies are needed to assess the accuracy of the test in detecting sepsis in asymptomatic newborns and its clinical impact on neonatal health.

Corresponding author: EXK958@bham.ac.uk

References
1. Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, et al. Pulse oximetry screening for congenital heart defects in newborn infants ( PulseOx): a test accuracy study. Lancet. 2011;378(9793):785-794

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