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