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Telephonic survey of the use of pulse oximetry as part of routine baby checks S Goyal, S Sen.

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Presentation on theme: "Telephonic survey of the use of pulse oximetry as part of routine baby checks S Goyal, S Sen."— Presentation transcript:

1 Telephonic survey of the use of pulse oximetry as part of routine baby checks
S Goyal, S Sen

2 Overview Background Results Discussion Conclusion
Burden of the problem Earlier practice Pulse oximetry Validity of pulse oximetry Evidence Results Discussion Conclusion

3 The burden of the problem
Congenital heart diseases (CHD)  7-8 / 1000 LB Leading cause of death due to malformations Cyanotic CHD  3 / 1000 LB Critical CHD  1 / 1000 LB 15-30% of such infants leave hospital without the malformation being recognised Undiagnosed – collapse, shock, poor outcome With pulse-oximetry, early detection & diagnosis improved outcome

4 Pulse oximetry Pulse oximetry is a non-invasive method allowing the monitoring of the % oxygen saturation of a patient's haemoglobin Objective quantification of hypoxemia Acceptable to parents and clinical staff Superior sensitivity to that of AN screening and clinical examination. Adjuvant to examination

5 Pulse oximetry Highly specific test (i.e. minimal false positives)
Moderately high sensitivity (i.e. true positives) Meets criteria for ‘universal screening’ Early detection of potentially lethal critical CHDs Also identifies serious non-cardiac conditions

6 Meta-analysis (Thangaratinam et al 2011)
13 eligible studies;  babies from Detected  Systematic review and meta-anlaysis cases; 0.7/1000 LB High specificity; mod high sensitivity Low overall false positivity rate At <24 hrs age, more false +ve, no change in sensitivity No difference in post ductal v/s pre + post ductal

7 Gwent experience (Sen, J Mat Fetal Neonatal Medicine 2014)
3 year data (2007 to 2009) : data on 6329 babies CCHD: Clinical Examination and Pulse Oximetry (%) Unwell Infant: Clinical Examination and Pulse Oximetry Sensitivity 90.9 93.3 Specificity 99.9 100 +ve Predictive Value 71.4 -ve Predictive Value

8 Practice in UK 2011 (Kang et al) – 7% of units had pulse oximetry screening 2013 (Singh et al) all 204 neonatal units, 36 (18%) had routine pulse oximetry AAP recommends routine pulse oximetry as a part of newborn screening, but not all states in the US currently consider it mandatory Under consideration from BAPM

9 Survey Aim To determine the extent to which pulse-oximetry is used as a screening test in the neonatal units of the UK Methods A telephonic survey 55 neonatal units in England and Wales June-July 2013

10 Survey Results 53 units responded
Only 17 (32%) units use pulse-oximetry as a part of their routine baby check 9 were NICUs, 6 were LNUs and 2 were SCBUs All units had started using pulse oximetry between 2 weeks and 7 years (mean 2 years)  Heterogeneity of practice noted 11 units used post-ductal saturations alone while rest 6 used both pre-ductal and post-ductal saturations.

11 Discussion Timing : < or > 24 hr of age?
Post ductal saturation or both pre & post ductal? Non cardiac anomalies – false positives False negatives Some CHD like aortic arch anomalies/Fallot’s still may be missed

12 Conclusion An increase in number of the units using pulse oximetry as a part of routine baby checks No uniform protocol A national guideline is required to make pulse-oximetry a standard and routine part of baby checks


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