Pulse oximetry

Public Health England hosts the UK National Screening Committee

Use of Pulse Oximetry in

Screening for Critical Congenital

Heart Disease in Newborns

Dr Graham Shortland

Pulse Oximetry testingWhat is it?

• Device used to measure oxygen level (oxygen saturation) of the blood.

Why use it in Newborn Screening for CCHD?

• Already commonly used in hospitals

• Easy to administer and non-invasive

• Oxygen saturation in newborn babies is indicator of congenital heart defect

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Background• major trial published by Ewar et al. 2012 on Pulse oximetry screening.

Trial aimed to determine:

• accuracy,

• acceptability and

• cost-effectiveness

• 2013 UK NSC review:

“The UK NSC recommends piloting the use of pulse oximetry test

to evaluate the potential benefits of its use as a new screening test

for congenital heart disease”


Pulse Oximetry Pilot

Aims

• to evaluate the feasibility of implementing newborn PO screening

• establish effect of PO on clinical services

Design

• Two phases:

• Phase one: 27th February 2015 baseline assessment questionnaire +

retrospective data collection

• Phase two:

• Prospective ‘baseline’ data collection prior to change/ implementation of

PO screening pathway.

• Pilot PO screening undertaken 1st July – 31st December 2015:


Findings• Pulse ox protocol used

• 32,597 newborn babies screened for CCHD using pulse oximetry

• Total of 239 ‘screen positive’ cases (0.73% screen positive rate)

• Yield of 8 CCHD (true positive cases)

• 86 significant non-CCHD cases identified

• 2 CCHD cases missed (False negatives)

• No increase in NNU admissions or echocardiograms or cardiology

consultations as a result

• Feasibility/ burden not robustly captured

• Some trusts experienced staffing and time constraints

• Further cost-effectiveness analysis needed


UK National Screening Committee

• Discussed at June 2016 UK NSC meeting

Recommendation

‘The cost effectiveness of PO screening be examined taking into account all

screen positive babies.’

• Request that the findings from the cost effectiveness model be brought back

to the committee for discussion in due course


References• Ewer AK et al. 2012 Pulse oximetry as a screening test for congenital heart defects in newborn

infants: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health

Technology Assessment. 2012;16(2):v-xiii, 1-184. doi: 10.3310/hta16020.

• http://legacy.screening.nhs.uk/congenitalheartdisease


http://legacy.screening.nhs.uk/congenitalheartdisease

Protocol Used for Pulse Oximetry Pilot


Government & Nonprofit

Pulse oximetry