G160 Neonatal pulse oximetry screening: an evaluation of current clinical practice

Abstract

Introduction Interest in neonatal pulse oximetry screening (POS) for critical congenital heart defects is increasing. In January 2014 POS was implemented in the Rosie Hospital for all hospital births. Following national consultation, in March 2014, the UK National Screening Committee made the decision to pilot the use of POS. Aims 1. To assess adherence to the local guideline on pulse oximetry screening in neonates 2. To study the outcome of children with positive pulse oximetry test Methodology A retrospective cross-sectional study of babies born in the Rosie Hospital was performed and samples were collected randomly. Data were collected from the hand-held postnatal care records. Results POS results were documented in 552 of the 595 case notes studied. 55% of these had screening within recommended time (within 4-12 h of delivery). The majority of those performed outside of this time frame were after 12 h. 16 of the 552 neonates had low SpO2 upon first measurement. Repeat pulse oximetry was documented in 13 of these 16 neonates; values were ≥95% in 11 infants on repeat. One infant was found to have complete atrio-ventricular septal defect (AVSD) whilst one had persistent fetal circulation. The 3 remaining neonates with low SpO2 had no documented follow up or outcome in the maternal hand-held notes prior to discharge. Further investigation of hospital notes confirmed one of these infants had significant sepsis and mild persistent pulmonary hypertension of newborn (PPHN), one was treated for suspected sepsis, whilst the third had a structurally normal heart with transitional circulation. Conclusions Overall, new clinical practice in POS has been widely embraced by staff in Cambridge; however, adherence to the guideline and documentation could be improved in the Rosie Hospital. In our study, false positives accounted for <0.8% of results; most infants with false positive POS had other noncardiac pathologies.