Pulse Oximetry Screening for Critical Congenital Heart Disease after Home Birth and Early Discharge

• Published in: The Journal of pediatrics 2016-03, Vol.170, p.188-192.e1
• Main Authors: Narayen, Ilona C., MD, Blom, Nico A., MD, PhD, Bourgonje, Marjolein S., RN, Haak, Monique C., MD, PhD, Smit, Marrit, RM, PhD, Posthumus, Fennie, RM, van den Broek, Annique J.M., MD, Havers, Hester M., MD, te Pas, Arjan B., MD, PhD
• Format: Article
• Language: English
• Subjects: Feasibility Studies; Female; Heart Defects, Congenital - diagnosis; Home Childbirth; Humans; Hypertension, Pulmonary - diagnosis; Infant, Newborn; Infection - diagnosis; Meconium Aspiration Syndrome - diagnosis; Midwifery; Netherlands; Oximetry - statistics & numerical data; Oxygen - blood; Parental Consent - statistics & numerical data; Patient Discharge; Pediatrics; Polycythemia - diagnosis; Pregnancy; Prospective Studies; Time Factors
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.12.004

Objectives To assess the feasibility of pulse oximetry (PO) screening in settings with home births and very early discharge. We assessed this with an adapted protocol in The Netherlands. Study design PO screening was performed in the Leiden region in hospitals and by community midwives. Measurements were taken ≥1 hour after birth and on day 2 or 3 during the midwife visit. Primary outcome was the percentage of screened infants with parental consent. The time point of screening, oxygen saturation, false positive (FP) screenings, critical congenital heart defects (CCHDs), and other detected pathology were registered. Results In a 1-year period, 3625 eligible infants were born. Parents of 491 infants were not approached for consent, and 44 refused the screening. PO screening was performed in 3059/3090 (99%) infants with obtained consent. Median (IQR) time points of the first and second screening were 1.8 (1.3-2.8) and 37 (27-47) hours after birth. In 394 infants with screening within 1 hour after birth, the median pre- and postductal oxygen saturations were 99% (98%-100%) and 99% (97%-100%). No CCHD was detected. The FP prevalence was 1.0% overall (0.6% in the first hours after birth). After referral, important noncritical cardiac and other noncardiac pathology was found in 62% of the FP screenings. Conclusions PO screening for CCHD is feasible after home births and very early discharge from hospital. Important neonatal pathology was detected at an early stage, potentially increasing the safety of home births and early discharge policy.