Post-implementation review of pulse oximetry screening of well newborns in an Australian tertiary maternity hospital
- Conflict of interest: None.
Despite there being evidence that pulse oximetry screening is better than clinical examination alone in early detection of CHD, implementation has been slow. The aim of this paper was to evaluate the practice after its implementation into routine care at Royal Prince Alfred Hospital in 2008.
A single pulse oximetry measurement was incorporated in the routine discharge newborn examination or, with early discharge, as a part of the Midwife Discharge Support Programme. An oxygen saturation level greater than or equal to 95% was considered normal, and a level less than 95%, confirmed on a repeat measure, triggered a review and examination by a consultant neonatal paediatrician. The saturation levels were recorded in the hospital database. Ascertainment of major CHD requiring surgery in the first 12 months was performed by searching the cardiac surgery database of the Heart Centre for Children.
A total of 18 801 babies were screened over a 42-month period. Of these, four babies with major CHD were diagnosed prior to discharge with the main clinical alert resulting from routine pulse oximetry screening (true positive). Of the 11 cases with saturation <95% but no CHD (false positive cases), six had respiratory pathology. One baby with normal saturation level needed surgery in the first year for a large ventricular septal defect (false negative). The false positive rate of pulse oximetry screening for CHD was 0.13% with sensitivity 80%, specificity of 99.8%, a positive predictive value of 13.3% and a negative predictive value of 99.9%. Nine additional echocardiogram were required over 42 months.
These post-implementation data confirm that pulse oximetry screening increases early diagnosis of major CHD as well as other important pathology with a very low false positive rate and minimal requirement for extra echocardiograms. Pulse oximetry screening of apparently well newborns should become a standard of care.