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The newborn examination is a universally accepted method to screen for congenital heart disease (CHD); however, failure of detection has been estimated to be in excess of 25%.1 Antenatally, only 23.4% of CHD is diagnosed by obstetric ultrasound screening with variable diagnostic rates nationally.2 Recent studies have reported improved detection rates with the use of pulse oximetry (PO) and demonstrated the cost-effectiveness of such screening.3 4 We surveyed the practice of PO as a part of routine neonatal examination in hospitals across the UK.
Methods
All hospitals with delivery units were contacted by telephone. A standardised questionnaire was used to establish whether PO was performed on all newborns before discharge, what screening protocol was used and subsequent management if an abnormal result was obtained.
Results
Of the 224 units (100% response rate), only 15 units (7%) routinely used PO to supplement the postnatal examination. Five units measured preductal and postductal saturations, nine units measured only postductal saturations and one unit measured only preductal saturations. There were differences in the values used to trigger further investigation: five units used a cut-off value of less than 94%, five units used <95%, two units used <96%, two units used a difference of greater than 3% between upper and lower limbs and one unit used two criteria of <95% and <2% difference between preductal and postductal saturations.
Where oxygen saturation measurements were abnormal, echocardiography was performed locally in 13 units (8 by neonatologists, 3 by paediatricians with expertise in cardiology and 2 by echocardiography technicians), while 2 units referred to another hospital. In addition to echocardiography, two units performed chest x-ray (CXR), three units performed ECG and two units performed both CXR and ECG.
Conclusions
We found a low uptake of PO screening as a part of postnatal examination to detect CHD and inconsistent practice where PO is used. Implementation of PO screening may be dictated by financial and human resources. PO screening will present many challenges to service provision such as staff training and timing of measurement. Importantly, there will need to be careful thought as to how babies with abnormal PO measurements will be investigated and where this will be undertaken. Echocardiographic evaluation of a positive screening result should be readily available to allay parental anxiety and to avoid delay in hospital discharge or transfer to another hospital. If PO screening is to be implemented, national guidelines should be developed both for the saturation measurements and for subsequent investigations.
Supplementary materials
adc.2010.206631
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Footnotes
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.