Pulse oximetry screening for critical congenital heart defects

Plana, María Nieves; Zamora, Javier; Suresh, Gautham; Fernández-Pineda, Luis; Thangaratinam, Shakila; Ewer, Andrew K

doi:10.1002/14651858.cd011912.pub2

Cited by 133 publications

(162 citation statements)

References 93 publications

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“…The simplicity of performing the test on one limb was an important consideration as significant concerns were raised about the impact of the test on the workload of midwives. The Cochrane systematic review found no difference in sensitivity or specificity for pulse oximetry screening between post‐ductal screening alone and preductal and post‐ductal screening . Therefore, to optimise uptake and decrease workload, a decision was made that post‐ductal screening was most appropriate in this setting.…”

Section: Discussionmentioning

confidence: 69%

“…We sought to identify cardiac‐related deaths in infants born alive during the study period at any of the three participating districts. Deaths and cardiac interventions in the first 28 days after birth were identified to satisfy this definition commonly used to describe a ‘critical’ congenital cardiac defect …”

Section: Methodsmentioning

confidence: 99%

“…Deaths and cardiac interventions in the first 28 days after birth were identified to satisfy this definition commonly used to describe a 'critical' congenital cardiac defect. 9 Study guidelines and resources were developed prior to the introduction of screening. 10 Post-ductal oxygen saturations were measured on well newborn infants with a gestational age of ≥35 weeks.…”

Section: Me Thodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Me Thodsmentioning

confidence: 99%

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

et al. 2019

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“…Critical cardiac anomalies may not produce visible cyanosis, but a degree of hypoxaemia will be present in the majority of these infants. This has led to the utilisation of pulse oximetry as a screening tool to identify underlying cardiac disease in newborn infants, and in the last decade, pulse oximetry screening has become an established practice in many parts of the world . Some have, however, cited high antenatal detection rates as the reason for not considering the introduction of pulse oximetry screening …”

Section: Introductionmentioning

confidence: 99%

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

et al. 2019

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Aim Assess the potential additional benefit from pulse oximetry screening in the early detection of critical congenital heart disease in a country with a well‐developed antenatal ultrasound screening programme. Methods Live‐born infants, pregnancy terminations and stillbirths from 20 weeks’ gestational age, between 2013 and 2015, with critical cardiac defects defined as primary or secondary targets of pulse oximetry screening were identified. Critical defects were those resulting in the death of a fetus or an infant in the first 28 days after birth, or a defect requiring intervention in the first 28 days. Results Two hundred and sixty‐eight infants and Fetuses were identified. Antenatal detection rates improved from 69% to 77% over the study period. An associated co‐morbidity improved antenatal detection rates. Twenty‐seven live‐born infants were diagnosed after discharge: 15 aortic arch obstruction (AAO); 10 d‐loop transposition of the great arteries (d‐TGA), and two total anomalous pulmonary venous drainage (TAPVD). Of these, five with AAO, nine with d‐TGA and likely both with TAPVD could potentially have been detected with oximetry screening. Conclusion The antenatal detection of critical cardiac anomalies continues to improve in New Zealand. Despite high antenatal detection rates for most lesions, universal postnatal oximetry screening has the potential to improve early detection.

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“…Pulse oximetry (PO) screening to detect critical congenital heart defects (CCHD) in newborns has been studied widely in the past years and was proven to be accurate, safe, easy, and acceptable in settings with delivery and screening in hospital [6, 12, 15, 23, 30]. Cost-effectiveness analyses performed in studies from the USA and UK also suggest that the screening might be cost-effective in their setting [21, 25].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

et al. 2018

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Pulse oximetry (PO) screening is used to screen newborns for critical congenital heart defects (CCHD). Analyses performed in hospital settings suggest that PO screening is cost-effective. We assessed the costs and cost-effectiveness of PO screening in the Dutch perinatal care setting, with home births and early postnatal discharge, compared to a situation without PO screening. Data from a prospective accuracy study with 23,959 infants in the Netherlands were combined with a time and motion study and supplemented data. Costs and effects of the situations with and without PO screening were compared for a cohort of 100,000 newborns. Mean screening time per newborn was 4.9 min per measurement and 3.8 min for informing parents. The additional costs of screening were in total €14.71 per screened newborn (€11.00 personnel, €3.71 equipment costs). Total additional costs of screening and referral were €1,670,000 per 100,000 infants. This resulted in an incremental cost-effectiveness ratio of €139,000 per additional newborn with CCHD detected with PO, when compared to a situation without PO screening. A willingness-to-pay threshold of €20,000 per gained QALY for screening in the Netherlands makes the screening likely to be cost-effective.Conclusion: PO screening in the Dutch care setting is likely to be cost-effective. What is Known: • Pulse oximetry is increasingly implemented as a screening tool for critical congenital heart defects in newborns.• Previous studies suggest that the screening in cost-effective and in the USA a reduction in infant mortality from critical congenital heart defects was demonstrated. What is New: • This is the first cost-effectiveness analysis for pulse oximetry screening in a setting with screening after home births, with screening at two moments.• Costs of pulse oximetry screening in a setting with hospital and homebirth deliveries were €14.71 and is likely to be cost-effective accordint to Dutch standards.

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Pulse oximetry screening for critical congenital heart defects

Abstract: Pulse oximetry is a highly specific and moderately sensitive test for detection of CCHD with very low false-positive rates. Current evidence supports the introduction of routine screening for CCHD in asymptomatic newborns before discharge from the well-baby nursery.

Cited by 133 publications

References 93 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

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

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