Newborn Pulse Oximetry Screening

The aim of this research was to develop an understanding of the burden and characteristics of critical congenital heart disease (CHD) in New Zealand and to establish whether it is feasible for New Zealand to introduce nationwide pulse oximetry screening for the detection of these anomalies in newborns. Data from national databases were merged to compile a dataset of infants and fetuses with critical cardiac disease in New Zealand between 2006 and 2015, which was interrogated to determine the incidence and characteristics of cardiac anomalies. An intervention study of pulse oximetry screening was introduced at hospitals and primary maternity units in three Health Boards. The study was conducted over a 2-year period and was preceded by consultation with stakeholder groups. Well infants with a gestation of 35 weeks or greater were eligible for screening. An oxygen saturation of equal or greater than 95% was a pass result. Participant demographics, test results and medical care following a failed test were recorded. Consumer satisfaction was assessed with a survey. Antenatal detection rates for critical CHD improved over time. Currently >75% are diagnosed before birth. An antenatal diagnosis of aortic arch obstruction and transposition of the great arteries was associated with decreased mortality (1/97, 1% vs. 11/156, 7%; p = 0.03) while birth outside the surgical centre was associated with increased risk of mortality (11/147, 7% compared with 1/106, 1%; p = 0.02). The incidence of left heart obstruction was significantly higher among Europeans (0.59 per 1,000) compared with Māori (0.31 per 1,000; p <0.001) and Pacific Peoples (0.27 per 1,000; p = 0.002). Total case fatality was, however, lower in Europeans compared to other ethnicities (42% v. 63%; p=0.002). Oximetry screening was performed on 16,644 of 27,172 (61%) eligible infants. Forty-eight (0.3%) infants failed to reach saturation targets: 3 had critical cardiac disease; 34 had significant other pathology, and 11 had no pathology. There were significant associations between screening rates and demographic variables with lower rates recorded for Māori, Pacifica, the socioeconomically deprived and those not registered with a maternity care provider. Consumers were satisfied with the screening procedure and the quality of information provided. Despite a well-developed antenatal screening programme, late-diagnosed infants remain at risk. The introduction of pulse oximetry screening can identify these infants, but sector-led initiatives may perpetuate inequity. A nationally-led screening programme is most likely to optimise health outcomes for all infants born with critical cardiac anomalies and will be well received by consumers.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Paediatrics

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2019

Author dc:creator

• Cloete, Hester

Advisors dc:contributor.advisor

• Bloomfield, F
• Gentles, T

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/48854

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/48854