Newborn oxygen saturation at mild altitude versus sea level: implications for neonatal screening for critical congenital heart disease

Samuel, Tal Y; Bromiker, Reuben; Mimouni, Francis; Picard, Elie; Lahav, Sigalit; Mandel, Dror; Goldberg, Shmuel

doi:10.1111/apa.12155

Cited by 26 publications

(23 citation statements)

References 20 publications

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“…Samuel 21 found average preductal functional saturations of 97.86% to 98.49% with a 2 SD range encompassing 94.7% to 100% from 2559 feet (780 m). Thilo et al 16 found term postductal saturations of 92% to 93% with a range of 80% to 98% and a 2 SD value of 85% in Denver (5280 feet/1610 m); however, they used fractional saturation technology, and saturation results in their study are likely lower secondary to this.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Critical Congenital Heart Disease Newborn Screening at Moderate Altitude

et al. 2014

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BACKGROUND AND OBJECTIVE: Consensus guidelines have recommended newborn pulse oximetry screening for critical congenital heart disease (CCHD). Given that newborn oxygen saturations are generally lower at higher altitudes, the American Academy of Pediatrics and others recommend additional evaluation of the screening algorithm at altitude. Our objective was to evaluate the feasibility of newborn pulse-oximetry CCHD screening at moderate altitude (Aurora, CO; 1694 m). We hypothesized the overall failure rate would be significantly higher compared with published controls. METHODS: We enrolled 1003 consecutive infants at ≥35 weeks’ gestation in a prospective observational study. The nationally recommended protocol for CCHD screening was adhered to with the exceptions of no reflex echocardiograms being performed and providers being informed of results only if saturations were less than predefined critical values. RESULTS: There were 1003 infants enrolled, and 988 completed the screen. The overall failure rate for completed screenings was 1.1% (95% confidence interval: 0.6%–2.0%). The first 500 infants had 1.6% fail, and the last 503 infants had 0.6% fail. Among infants who failed screening, 73% failed secondary to saturations <90%, whereas saturations between 90% and 94%, persistently >3% difference, and multiple criteria were each responsible for 9% of failures. Overall, 1.6% of all infants had incomplete screening and had not passed at the time the test was stopped. CONCLUSIONS: Pulse oximetry screening failure rates at moderate altitude are significantly higher than at sea level. Larger studies with alternative algorithms are warranted at moderate altitudes.

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Section: Discussionmentioning

confidence: 99%

“…F, foot; RH, right hand. e566previous studies 14,15,21 and add strength to this data pool by including such a large sampling of infants.…”

Section: Figurementioning

confidence: 99%

Feasibility of Critical Congenital Heart Disease Newborn Screening at Moderate Altitude

et al. 2014

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“…Newborn measurements were obtained from a reanalysis of data obtained in a previous study that we published elsewhere. 12 Briefly, data collected from newborns aged 25-67 hours who were born either at the Shaare Zedek Medical Center, Jerusalem, Israel (760 m above sea level) or at the Lis Maternity Hospital, Tel Aviv, Israel (sea level) were analyzed. Only healthy, term, appropriate for gestational age newborns of nonsmoking mothers were enrolled.…”

Section: Met Hod Smentioning

confidence: 99%

Sex‐linked difference in blood oxygen saturation

Levental

Picard

Mimouni

et al. 2018

Clinical Respiratory J

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“…However, research is currently being conducted to determine if screening algorithms should be adjusted, based on elevation. There is evidence that alternative algorithms are warranted at moderate altitudes (2500–5500 feet) [Samuel et al 2013; Wright et al 2014). …”

Section: Resultsmentioning

confidence: 99%

Critical Congenital Heart Disease Newborn Screening Implementation: Lessons Learned

McClain

Hokanson

Grazel

et al. 2017

Matern Child Health J

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Introduction The purpose of this article is to present the collective experiences of six federally-funded critical congenital heart disease (CCHD) newborn screening implementation projects to assist federal and state policy makers and public health to implement CCHD screening. Methods A qualitative assessment and summary from six demonstration project grantees and other state representatives involved in the implementation of CCHD screening programs are presented in the following areas: legislation, provider and family education, screening algorithms and interpretation, data collection and quality improvement, telemedicine, home and rural births, and neonatal intensive care unit populations. Results The most common challenges to implementation include: lack of uniform legislative and statutory mandates for screening programs, lack of funding/resources, difficulty in screening algorithm interpretation, limited availability of pediatric echocardiography, and integrating data collection and reporting with existing newborn screening systems. Identified solutions include: programs should consider integrating third party insurers and other partners early in the legislative/statutory process; development of visual tools and language modification to assist in the interpretation of algorithms, training programs for adult sonographers to perform neonatal echocardiography, building upon existing newborn screening systems, and using automated data transfer mechanisms. Discussion Continued and expanded surveillance, research, prevention and education efforts are needed to inform screening programs, with an aim to reduce morbidity, mortality and other adverse consequences for individuals and families affected by CCHD.

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Newborn oxygen saturation at mild altitude versus sea level: implications for neonatal screening for critical congenital heart disease

Abstract: At MA, SpO2 is approximately 0.4% lower compared with SL. Our study supports the AAP recommendation suggesting algorithm cut-offs may need adjustment in high-altitude nurseries and suggest broadening it to MA as well.

Cited by 26 publications

References 20 publications

Feasibility of Critical Congenital Heart Disease Newborn Screening at Moderate Altitude

Feasibility of Critical Congenital Heart Disease Newborn Screening at Moderate Altitude

Sex‐linked difference in blood oxygen saturation

Critical Congenital Heart Disease Newborn Screening Implementation: Lessons Learned

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