Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T21:50:15.712Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact and efficacy of routine pulse oximetry screening for CHD in a local hospital

Published online by Cambridge University Press:  24 February 2016

Andrew J. Jones ,
Claire Howarth ,
Richard Nicholl ,
Ezam Mat-Ali  and
Rachel Knowles Open the ORCID record for Rachel Knowles [Opens in a new window]
Andrew J. Jones*
Affiliation:
Neonatal Intensive Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
Claire Howarth
Affiliation:
Neonatal Intensive Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
Richard Nicholl
Affiliation:
Neonatal Intensive Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
Ezam Mat-Ali
Affiliation:
Neonatal Intensive Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
Rachel Knowles
Affiliation:
UCL Institute of Child Health, London, United Kingdom
*
Correspondence to: A. J. Jones, MA, MBBS, MRCPCH, MSc, Neonatal Intensive Care Unit, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, United Kingdom. Tel: 020 8869 3941; Fax: 020 8869 2927; E-mail: andrewjones7@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The objective of this study was to evaluate the impact and efficacy of pulse oximetry screening for CHD in a level-two neonatal unit without on-site access to paediatric echocardiography.

Methods

All neonatal unit admissions between 1 September, 2011 and 31 August, 2013 were reviewed to determine the outcomes of newborns identified by pulse oximetry screening. Record linkage with the National Congenital Heart Disease Audit allowed follow-up of newborns with a negative screening result.

Results

There were 11,233 live births during the study period, with 973 neonatal unit admissions unrelated to pulse oximetry screening. From the remaining screening population of 10,260 newborns, 23 were admitted on the basis of a screen-positive result; three of the 23 patients went on to have urgent echocardiograms, and two were found to have critical CHD. In the 21 newborns without critical CHD, an alternative diagnosis was made in 16 cases. Record linkage with the National Congenital Heart Disease Audit indicated that no newborns born in the hospital during the study period received surgery for critical CHD following negative screening. The estimated sensitivity of screening was 100% (95% confidence interval 15.81–100%) and specificity was 99.80% (95% confidence interval 99.69–99.87%), with a false-positive rate of 0.20% (95% confidence interval 0.13–0.31%).

Conclusion

The introduction of pulse oximetry screening to a hospital where paediatric echocardiography services are not available is practical, results in very few referrals to the regional paediatric cardiology centre, and detects cases of CHD that would otherwise go undiagnosed. Record linkage with a national CHD database provides a straightforward method for tracking cases of CHD that may have been missed by screening.

Keywords

Neonatologyscreeningechocardiographypulse oximetryCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1397 - 1405
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Barrington, KJ. Neonatal screening for life threatening congenital heart disease. BMJ 2009; 338: a2663.Google Scholar
2. Brown, KL, Ridout, DA, Hoskote, A, et al. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 2006; 92: 1298–1302.Google Scholar
3. Public Health England. Population screening programmes, 2015. Retrieved September 28, 2015, from https://www.gov.uk/topic/population-screening-programmes.Google Scholar
4. National Institute for Cardiovascular Outcomes Research (NICOR). Antenatal diagnosis of congenital heart disease, 2013. Retrieved September 28, 2015, from https://nicor4.nicor.org.uk/CHD/an_paeds.nsf/vwContent/Antenatal%20Diagnosis?Opendocument.Google Scholar
5. Chew, C, Halliday, JL, Riley, MM, et al. Population-based study of antenatal detection of congenital heart disease by ultrasound examination. Ultrasound Obstet Gynecol 2007; 29: 619–624.Google Scholar
6. O’Donnell, CP, Kamlin, CO, Davis, PG, et al. Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed 2007; 92: F465–F467.CrossRefGoogle ScholarPubMed
7. Wren, C, Reinhardt, Z, Khawaja, K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed 2008; 93: F33–F35.CrossRefGoogle ScholarPubMed
8. Thangaratinam, S, Brown, K, Zamora, J, et al. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 2012; 379: 2459–2464.Google Scholar
9. Ewer, A, Furmston, A, Middleton, L, et al. Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technol Assess 2012; 16: v-xiii, 1–184.Google Scholar
10. Knowles, R, Hunter, R. Screening for Congenital Heart Defects. UCL, UK NSC, London, 2013.Google Scholar
11. Powell, R, Pattison, HM, Bhoyar, A, et al. Pulse oximetry screening for congenital heart defects in newborn infants: an evaluation of acceptability to mothers. Arch Dis Child Fetal Neonatal Ed 2013; 98: F59–F63.Google Scholar
12. Kang, S, Tobin, S, Kelsall, W. Neonatal pulse oximetry screening: a national survey. Arch Dis Child Fetal Neonatal Ed 2011; 96: F312.Google Scholar
13. Singh, A, Ewer, AK. Pulse oximetry screening for critical congenital heart defects: a UK national survey. Lancet 2013; 381: 535.Google Scholar
14. National Health Service (NHS). UK NSC newborn pulse oximetry screening pilot, 2015. Retrieved April 8, 2015, from http://webarchive.nationalarchives.gov.uk/20150408175925/http://newbornphysical.screening.nhs.uk/pulseoximetry.Google Scholar
15. Public Health England. NHS newborn and infant physical examination (NIPE) screening programme, 2015. Retrieved September 28, 2015, from https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-screening-programme-updates.Google Scholar
16. Clevermed. BadgerNet platform, 2015. Retrieved September 28, 2015, from http://www.clevermed.com/badgernet-platform/clinical-specialities/.Google Scholar
17. University College London (UCL). NICOR: National Institute for Cardiovascular Outcomes Research, 2015. Retrieved September 28, 2015, from https://www.ucl.ac.uk/nicor.Google Scholar
18. Chi, TPLKJ. The pulmonary vascular bed in children with Down syndrome. J Pediatr 1975; 86: 533–538.Google Scholar
19. Prudhoe, S, Abu-Harb, M, Richmond, S, et al. Neonatal screening for critical cardiovascular anomalies using pulse oximetry. Arch Dis Child Fetal Neonatal Ed 2013; 98: F346–F350.CrossRefGoogle ScholarPubMed
20. Singh, A, Rasiah, SV, Ewer, AK. The impact of routine predischarge pulse oximetry screening in a regional neonatal unit. Arch Dis Child Fetal Neonatal Ed 2014; 99: F297–F302.Google Scholar