Feasibility of pulse oximetry screening for critical congenital heart defects in homebirths

Cawsey, MJ; Noble, Sarah; Cross-Sudworth, Fiona; Ewer, Andrew K

doi:10.1136/archdischild-2015-309936

Cited by 15 publications

(11 citation statements)

References 8 publications

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“…They reported a false‐positive rate of 0.6% . Cawsey et al demonstrated that early pulse oximetry screening for home births is both feasible and acceptable among midwives in Birmingham.…”

Section: Discussionmentioning

confidence: 99%

Pulse oximetry screening in a midwifery‐led maternity setting with high antenatal detection of congenital heart disease

et al. 2019

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Aim To assess local and individual factors that should be considered in the design of a pulse oximetry screening strategy in New Zealand's midwifery‐led maternity setting. Methods An intervention study was conducted over 2 years. Three hospitals and four primary maternity units participated in the study. Post‐ductal saturation levels were measured on well infants with a gestation of ≥35 weeks. Infant activity and age (hours) at the time of the test were recorded. Results Screening was performed on 16 644 of 27 172 (61%) eligible infants. The age at which the screening algorithm was initiated varied significantly among centres. The probability of achieving a pass result (saturations ≥95%) in the context of no underlying pathology ranged from .94 for an unsettled infant screened <4 hours of age to .99 (P < .001) when the test was performed after 24 hours on a settled infant. Forty‐eight (0.3%) infants failed to reach saturation targets: 37 had significant pathology of which three had cardiac disease. Conclusion Screening practices were influenced by the setting in which it was undertaken. Infant activity and age at the time of testing can influence saturation levels. Screening is associated with the identification of significant non‐cardiac pathology.

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“…They reported a false‐positive rate of 0.6% . Cawsey et al demonstrated that early pulse oximetry screening for home births is both feasible and acceptable among midwives in Birmingham.…”

Section: Discussionmentioning

confidence: 99%

Pulse oximetry screening in a midwifery‐led maternity setting with high antenatal detection of congenital heart disease

et al. 2019

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“…There are concerns that very early screening in the first couple of hours may lead to an unacceptably high false-positive rate as more healthy babies with transitional circulation would test positive. Interestingly, recent studies from the Netherlands 17 and the United Kingdom 18 have shown the feasibility of screening home births as early as 1 hour after birth without creating a clinically unacceptable number of test positives. The Dutch study algorithm utilized a repeat test on day 2 or 3 whereas the United Kingdom study employed day 1 testing only.…”

Section: Screening Outside the Hospitalmentioning

confidence: 99%

Screening for Critical Congenital Heart Defects with Pulse Oximetry: Medical Aspects

Ewer

2016

Amer J Perinatol

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The detection of newborn babies with potentially life-threatening, critical congenital heart defects (CCHDs) before they collapse or expire remains an important clinical challenge. The absence of physical signs and the difficulty assessing mild cyanosis means that the newborn baby check misses up to a third of babies. Fetal anomaly ultrasound scanning identifies an increasing proportion, but this screen is operator-dependent and therefore highly variable; although some units report very high detection rates, overall most babies with CCHD are still missed. Pulse oximetry screening (POS) is an additional test that meets the criteria for universal screening. POS increases overall detection of CCHD to over 90% and also identifies babies with noncardiac, hypoxemic conditions (such as congenital pneumonia, early-onset sepsis, and pulmonary hypertension), which are usually included in the false positives. There is a wealth of published data on the POS, both in a research setting and more recently in routine clinical practice, and consideration of POS is becoming increasingly widespread particularly among high-income countries. But a degree of controversy still remains, and debate continues regarding the most appropriate time to screen, the most effective screening pathway, and screening outside the well-baby nursery. So, should all newborn babies be screened with POS, if so, when and where should screening take place, what saturations are acceptable, and which conditions are we trying to identify? This review will look at the available evidence and try to suggest the way forward for those considering its introduction into their clinical practice.

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“…Earlier studies have shown the feasibility of home-birth screening of CCHD with hospital-grade portable pulse oximeters [13,14,23]. Besides the Netherlands, rates of planned out-of-hospital birth (i.e., births intended to occur at home or at a freestanding birth center) have increased in high- and middle-income countries [24,25,26].…”

Section: Discussionmentioning

confidence: 99%

Reliability and Validity of a Smartphone-Paired Pulse Oximeter for Screening of Critical Congenital Heart Defects in Newborns

Huizing

Villamor-Martínez²,

Chavagne³

et al. 2017

Neonatology

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Background: Barriers to widespread implementation of pulse oximetry screening of critical congenital heart defects (CCHD) in newborns include increasing trends of out-of-hospital births and cost of equipment. In recent years, smartphone-compatible pulse oximeters have appeared on the market, but the validity of such devices in the setting of CCHD screening has not been evaluated. Objectives: To compare the performance in CCHD screening of a smartphone-paired pulse oximeter (Masimo iSpO₂-Rx™) and a hospital-grade pulse oximeter (Masimo Radical-7™). Methods: Preductal (right hand) and postductal (either foot) saturations were determined in a population of 201 term newborns by 2 independent teams, one using the Radical-7 and the other using the iSpO₂-Rx. Bland-Altman analysis was applied to calculate mean bias and 95% limits of agreement between the 2 pulse oximeters. Results: For the preductal oxygen saturation, the mean bias (Radical-7 minus iSpO₂-Rx) was -0.08 (SD 1.76) and the lower and upper limits of agreement were -3.52 and 3.36, respectively. For the postductal oxygen saturation, the mean bias was -0.11 (SD 1.68) and the lower and upper limits of agreement were -3.49 and 3.18, respectively. In addition, the iSpO₂-Rx provided reliable measurements of saturations below 95% in a group of 12 infants admitted to the neonatal intensive care unit. Conclusions: Our data suggest that CCHD screening with the Masimo iSpO₂-Rx is feasible and accurate. The use of reliable smartphone-paired pulse oximeters may contribute to the extension of CCHD screening to home births and low resource settings.

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Feasibility of pulse oximetry screening for critical congenital heart defects in homebirths

Abstract: Early pulse oximetry screening for homebirths is both feasible and acceptable.

Cited by 15 publications

References 8 publications

Pulse oximetry screening in a midwifery‐led maternity setting with high antenatal detection of congenital heart disease

Pulse oximetry screening in a midwifery‐led maternity setting with high antenatal detection of congenital heart disease

Screening for Critical Congenital Heart Defects with Pulse Oximetry: Medical Aspects

Reliability and Validity of a Smartphone-Paired Pulse Oximeter for Screening of Critical Congenital Heart Defects in Newborns

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