The impact of routine pulse oximetry screening on the echocardiography service in a tertiary neonatal unit

AbstractObjectivesThe 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.MethodsAll 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.ResultsThere 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%).ConclusionThe 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.

Download Full-text

The Impact of Routine Pulse Oximetry Use on Outcomes in COVID-19-Infected Patients at Increased Risk of Severe Disease: A Retrospective Cohort Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3804758 ◽

2021 ◽

Author(s):

Noluthando Nematswerani ◽

Shirley Collie ◽

Tommy Chen ◽

Michael Cohen ◽

Jared Champion ◽

...

Keyword(s):

Pulse Oximetry ◽

Retrospective Cohort ◽

Severe Disease ◽

Cohort Analysis ◽

Retrospective Cohort Analysis ◽

Increased Risk ◽

The Impact ◽

Routine Pulse Oximetry

Download Full-text

Newborn pulse oximetry screening for critical congenital heart defects

BMC Pediatrics ◽

10.1186/s12887-021-02520-7 ◽

2021 ◽

Vol 21 (S1) ◽

Author(s):

Sophie Jullien

Keyword(s):

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Current Evidence ◽

Supporting Evidence ◽

Manual Search ◽

Antenatal Ultrasonography ◽

The Impact ◽

Pulse Oximetry Screening

AbstractWe looked at existing recommendations and supporting evidence addressing the effectiveness of pulse oximetry effective for detecting critical congenital heart defects (CCHDs) in newborns. We also looked at the impact of timing of oximetry and the site of testing in the accuracy of screening, and at the potential harms and limitations of pulse oximetry screening,We conducted a literature search up to the 13th of August 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported.Current evidence supports consistent accuracy for detection of CCHDs in newborns by pulse oximetry screening in addition to antenatal ultrasonography and clinical examination. Overall, early diagnosis of CCHD with pulse oximetry is judged to be beneficial and cost-effective, and potential harms associated with false-positive tests are not serious, while missing CCHDs and other serious diseases detected by hypoxaemia in absence of pulse oximetry screening can lead to serious consequences. The site of testing (post-ductal versus pre- and post-ductal) had no significant effect on sensitivity nor specificity for detection of CCHDs.

Download Full-text

COST-EFFECTIVENESS OF PULSE OXIMETRY SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS IN ONTARIO

Paediatrics & Child Health ◽

10.1093/pch/pxy054.044 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e17-e18

Author(s):

Amit Mukerji ◽

Amy Shafey ◽

Amish Jain ◽

Eyal Cohen ◽

Prakeshkumar Shah ◽

...

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Pulse Oximetry ◽

Incremental Cost ◽

Congenital Heart ◽

Heart Defects ◽

Cost Effective ◽

Pulse Oximetry Screening ◽

Quality Adjusted Life ◽

Routine Pulse Oximetry

Abstract BACKGROUND Critical congenital heart defects (CCHDs) are a leading cause of morbidity and mortality in newborns, and late diagnosis is associated with mortality and worse outcomes. Many jurisdictions in the USA and elsewhere have implemented routine pulse oximetry screening (POS) for CCHD, which the Canadian Paediatric Society has recently endorsed. Cost-effective analyses in USA and Europe support this approach, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges with regard to POS implementation. OBJECTIVES To estimate the cost-effectiveness of POS for CCHD in the context of its implementation in Ontario, Canada. DESIGN/METHODS A cost-effectiveness analysis using a Markov model was conducted inputting values derived from an extensive review of literature, and using relevant local databases. The base-case was a 24-hour clinically stable infant born in Ontario. The model employed the healthcare payer (ministry of health) perspective and a life-time horizon. A number of mutually exclusive health states were created, representative of the natural course of CCHDs. The strategies compared were routine pulse oximetry screening versus no screening. Outcome measures, all discounted 1.5%, were quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios. An a priori threshold of CAD$4,166.67 per QALM (equivalent to CAD$50,000 per quality adjusted life year) was used. Probabilistic sensitivity analysis was conducted using multiple simulations of the model within expected range of variables included in the model. RESULTS The incremental cost of performing POS was estimated to be $27.27 per individual, with a gain of 0.02455 QALMs (Table 1). This yielded an incremental cost-effectiveness ratio (ICER), [Δ Cost / Δ QALMs] of CAD$1,110.79, well below the pre-determined threshold for cost-effectiveness. A probabilistic sensitivity analysis estimated a 93% chance of routine implementation of POS of being cost-effective, with majority of simulated ICERs lying below the threshold of acceptability (Figure 1). CONCLUSION Routine implementation of POS for CCHD is expected to be cost-effective with a high degree of certainty. Further validation of this model may be conducted following implementation to confirm these findings based on local population data.

Download Full-text

Impact of Pulse Oximetry Screening to Detect Congenital Heart Defects: 5 Years’ Experience in a Regional Neonatal Unit in the UK

10.21203/rs.3.rs-626454/v1 ◽

2021 ◽

Author(s):

Yogen Singh ◽

Si Emma Chen

Keyword(s):

Clinical Practice ◽

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Newborn Infants ◽

High Sensitivity ◽

Neonatal Unit ◽

Screening Tools ◽

Pulse Oximetry Screening

Abstract Pulse oximetry screening (POS) has been shown to be an effective and non-invasive investigation that can detect up to 50-70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on the clinical practice. All the eligible newborn infants born between Jan 2015 and Dec 2019 in busy regional neonatal unit were included in the prospective observational study. Of the 25185 eligible infants, 189 (0.8%) infants had a true positive results: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 infants had significant non-cardiac conditions. 43 infants who had a normal POS were later (post-hospital discharge) diagnosed with following category of CHDs: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7% and its specificity was 99.3%. However, its sensitivity for detection of all the major CHDs needing surgery during infancy was 33%.ConclusionPulse oximetry screening showed moderate and high sensitivity in detection of undiagnosed critical CHDs, however it failed to detect two-third of the major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods to detect other major CHDs missed by pulse oximetry screening and other current screening tools.

Download Full-text

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

European Journal of Pediatrics ◽

10.1007/s00431-021-04275-w ◽

2021 ◽

Author(s):

Yogen Singh ◽

Si Emma Chen

Keyword(s):

Clinical Practice ◽

Pulse Oximetry ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Newborn Infants ◽

High Specificity ◽

Neonatal Unit ◽

Screening Tools ◽

Pulse Oximetry Screening

AbstractPulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50–70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%.Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools. What is Known:• Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects.• Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee. What is New:• To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice.

Download Full-text