Temporal trends in routine predischarge pulse oximetry screening: 6 years' experience in a UK regional neonatal unit
Amy Henderson1, Diana Aguirre1, Anju Singh1
1Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK.
Insights
Pulse oximetry screening (POS) in neonatal units (NNU) improved congenital heart defect (CHD) detection rates. POS reduced admissions of healthy infants, decreasing workload and enhancing early diagnosis of critical CHDs.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Diagnostic Screening
Background:
- Pulse oximetry screening (POS) is a critical tool for early detection of critical congenital heart defects (CCHDs) in newborns.
- Neonatal units (NNUs) aim to optimize screening protocols to improve diagnostic accuracy and patient outcomes.
- Previous studies have established the efficacy of POS, but ongoing evaluation is necessary to track trends and refine practices.
Purpose of the Study:
- To assess the ongoing impact of POS within a regional NNU.
- To identify trends in screening outcomes and compare them with historical data.
- To evaluate the effectiveness of POS in detecting congenital heart defects (CHDs) and reducing unnecessary admissions.
Main Methods:
- A retrospective review of NNU admissions due to positive POS was conducted from April 2013 to March 2019.
- Data from the current study period were compared with previously published data from 2014.
- Infants included were those greater than 34 weeks gestation admitted following a positive POS.
Main Results:
- NNU admissions due to positive POS decreased from 0.8% to 0.5% of livebirths.
- The proportion of admitted infants with significant diagnoses increased to 97.6%, while healthy infant admissions decreased to 2.4%.
- Previously undiagnosed CHDs were identified in 9% of admitted infants, with 73% of all undiagnosed CCHDs detected via POS. Antenatal detection of CCHDs improved significantly.
Conclusions:
- Routine POS, alongside antenatal screening and postnatal examination, enhances overall CCHD detection rates.
- The study demonstrates a reduction in healthy infant admissions and associated workload following positive POS results.
- POS continues to be a valuable tool for improving the timely diagnosis and management of CHDs in neonates.
Objectives:
To evaluate the continued impact of pulse oximetry screening (POS) in a regional neonatal unit (NNU) and identify trends in screening outcomes in comparison with our previous experience.
Design:
Retrospective review of admissions between April 2013 and March 2019 (the current study) and comparison with previously published data (the 2014 study).
Patients:
All infants >34 weeks completed gestation admitted to NNU as a result of positive POS.
Outcome Measures:
Indication for admission, diagnosis, investigations and management.
Results:
There were 49 375 livebirths and 253 NNU admissions as a result of positive POS (0.5% of livebirths; compared with 0.8% in 2014). 247/253 (97.6%) of those admitted had a significant diagnosis requiring medical intervention (compared with 79% in 2014) and the proportion of healthy babies (with transitional circulation) admitted decreased from 21% to 2.4%.22 (9%) babies admitted as a result of a positive POS were found to have a previously undiagnosed congenital heart defect (CHD) of which eight were critical CHDs (CCHDs). This accounted for 73% of all undiagnosed CCHD undergoing POS. The antenatal detection rate of CCHD was 75% compared with 46% in 2014. No baby died or collapsed on the postnatal ward during the study period. The proportion of babies with CCHD identified before discharge improved from 94% to 99%.
Conclusions:
Routine POS, in addition to antenatal screening and postnatal examination, continues to contribute to the improvement of our overall CCHD detection rates. We have demonstrated an overall reduction in the admission of healthy babies and therefore workload following a positive test.
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