The document discusses the use of pulse oximetry in screening for critical congenital heart disease (CCHD) in newborns, highlighting its accuracy, acceptability, and cost-effectiveness based on trials. A pilot program screened 32,597 newborns, identifying 8 true positive CCHD cases and 239 screen positive instances, while noting some challenges such as staffing constraints. Further cost-effectiveness analysis is recommended by the UK National Screening Committee to evaluate the benefits of this screening method.

1. 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

2. Pulse Oximetry testing
What 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Protocol Used for Pulse Oximetry Pilot
8 Presentation title - edit in Header and Footer