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

2 Presentation title - edit in Header and Footer

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”

3 Presentation title - edit in Header and Footer

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:

4 Presentation title - edit in Header and Footer

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

5 Presentation title - edit in Header and Footer

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

6 Presentation title - edit in Header and Footer

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

7 Presentation title - edit in Header and Footer

Protocol Used for Pulse Oximetry Pilot

8 Presentation title - edit in Header and Footer