Newborn screening pulse oximetry to detect critical congenital heart disease: A follow-up survey of current practice at army, navy and air force hospitals

Abstract

Introduction: The purpose of this study was to assess the evolution of newborn pulse oximetry screening (+POx) among Army, Air Force, and Naval military hospitals (MH), including prevalence, protocol use, qualityassurance processes, access to echocardiography, and use of telemedicine. This is a follow-up from a prior study published in 2011. Materials and Methods: An Internet-based questionnaire was forwarded to the chief pediatrician at MHworldwide which support newborn deliveries. Descriptive data were reported using percentages. Grouped responses, asapplicable, were further compared using the chi-square test. A p-value < 0.05 was considered statistically significant.Results: Seventy-eight percent (36/46) of MH supporting deliveries worldwide responded to the survey (17 Army hospitals, 11 Navy Hospitals, 8 Air Force hospitals). All responding hospitals utilize +POx, of which 94% endorsed protocol compliance with the American Academy of Pediatrics guidelines. Nine (25%) hospitals were located outside of theUnited States. Delivery volumes (infants per month) range between 1-49 (36%), 50-99 (28%), 100-199 (19%), and200-300 (17%). Eleven hospitals reported regular review of +POx data, with most reviewing them monthly. Four MHshare findings with state institutions. Ten hospitals either have a staff pediatric cardiologist or use teleechocardiography for on-site evaluations. Ten hospitals are located greater than 60 miles from the nearest center withechocardiography capabilities. Of the five hospitals using tele-echocardiography, four confirmed critical congenitalheart disease (CCHD) using this practice, and all five reported averting transfer of an infant using this technology. Ofthe 22 hospitals lacking the ability to obtain on-site echocardiography, 12 (55%) are interested in implementing a teleechocardiography protocol. Conclusions: All responding MH use +POx, representing significant increase from the30% of MH reporting use of +POx seven years ago. The majority of MH follow AAP +POx guidelines, and thoughmost have providers review results prior to discharge, only one-third report periodic chart review for quality assurance.Most MH transfer infants with positive +POx results for evaluation due to a lack of on-site echocardiography. Teleechocardiography was reported as a potential solution to diagnose or rule out CCHD. Over half of remaining hospitalswithout cardiologists are interested in using this technology to evaluate stable infants with positive CCHD screening.