Feasibility of implementing pulse oximetry screening for congenital heart disease in a community hospital

Abstract

Objective:Pulse oximetry has been recognized as a promising screening tool for critical congenital heart disease (CCHD). The aim of this research was to study the feasibility of implementation in a community hospital setting.Study Design:Meetings were conducted to determine an implementation plan. Pulse oximetry was performed on the right hand and foot after 24 h of age. Newborns with a saturation ⩽95% or a ⩾3% difference were considered to have a positive screen. Screening barriers, screening time and ability to effectively screen all eligible newborns were noted.Result:From January 2009 through May 2010, of 6841 eligible newborns, 6745 newborns (98.6%) were screened. Of the nine infants with positive pulse oximetry screens, one had CCHD, four had CHD and four others were determined to have false positive screens. Average screening time was 3.5 min (0 to 35 min).Conclusion:Pulse oximetry can be implemented successfully in community hospitals without an excessive number of false positives or additional nursing staff.

Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

“…However, subsequent research from Europe has shown that echocardiography is not always needed if another condition is found to be causing the low blood oxygen saturation, and that only 29% of those that fail the screen require echocardiograms [35]. The number of false positives in the U.S. did not result in a large number of unnecessary echocardiograms once CCHD screening implementation was underway [29,34].…”

“…Systematic implementation was aided by the publication of a feasibility study conducted in Maryland, demonstrating that CCHD screening could be successfully implemented at a community hospital without the need for additional staff members, taking an average of only 3.5 min to screen and with few barriers [29]. Showing that CCHD screening was feasible in a community hospital was important.…”

Pulse Oximetry Screening in newborn for early detection of Critical Congenital Heart Disease - A review

“…Surprisingly, this screening test may miss transposition of great arteries occasionally, which is usually presented with cyanosis. 3,18,26 Both the parents and clinical staffs should be aware of the limitations of this screening test. Parents and caregivers should be informed that pulse oximetry cannot detect all cases of CCHD, and hence a negative test result does not exclude the possibility of heart disease.…”

“…Care of a case of circulatory collapse resulting from an undiagnosed CCHD may exceed the cost of screening of two thousand newborns. 26 Addition of pulse oximetry screening with clinical examination is cost effective with no risk of harm, and diagnostic echocardio-graphy should be performed in all test positive cases. In situation with a lower false positive rate and a lower antenatal detection, the cost effectiveness is likely to improved.…”

Screening for Critical Congenital Heart Disease: A Matter of Sensitivity

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It is with great interest that we read the letter by Dummula and Pandey [2] regarding the recent article entitled "False-Negative Pulse Oximetry Screening for Critical Congenital Heart Disease: The Case for Parent Education" [1]. Although much attention has been focused on children with a positive result (i.e., those who fail screening), little is known regarding children with a negative result (i.e., those who pass screening), particularly those with a false-negative result.

However, we wish to comment on a potential misconception regarding screening.

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