Pulse oximetry screening for critical congenital heart defects: a European consensus statement

Manzoni, Paolo; Martin, Gerard R.; Sánchez‐Luna, Manuel; Meštrović, Julije; Simeoni, Umberto; Zimmermann, Luc J. I.; Ewer, Andrew K; Granelli, Anne de Wahl; Fanaroff, Avroy A.; Narayen, Ilona C.; Luca, Danièle De; Thomas-Chabaneix, Julie; Orlikowsky, Thorsten; Soldatova, I.; Rodgers‐Gray, Barry; Carnielli, Virgilio P.; Vecchio, Antonio Del; Picardo, Sergio; Tulloh, Robert; Vento, Máximo

doi:10.1016/s2352-4642(17)30066-4

Cited by 41 publications

(23 citation statements)

References 11 publications

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“…However, in cases of suspicion of a non-critical defect or for patients with low pre-test probability a more expectative management can be provided. Moreover, the use of pulse-oximetry screening for congenital heart defects is useful and should be integrated into the clinical decision-making process, as internationally recommended [168,169].…”

Section: Discussionmentioning

confidence: 99%

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

et al. 2020

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Background: Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Methods: Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. Results: Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Conclusions: Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

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Section: Discussionmentioning

confidence: 99%

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

et al. 2020

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“…Pulse oximetry (PO) screening to detect critical congenital heart defects (CCHD) in newborns has been studied widely in the past years and was proven to be accurate, safe, easy, and acceptable in settings with delivery and screening in hospital [6, 12, 15, 23, 30]. Cost-effectiveness analyses performed in studies from the USA and UK also suggest that the screening might be cost-effective in their setting [21, 25].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

et al. 2018

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Pulse oximetry (PO) screening is used to screen newborns for critical congenital heart defects (CCHD). Analyses performed in hospital settings suggest that PO screening is cost-effective. We assessed the costs and cost-effectiveness of PO screening in the Dutch perinatal care setting, with home births and early postnatal discharge, compared to a situation without PO screening. Data from a prospective accuracy study with 23,959 infants in the Netherlands were combined with a time and motion study and supplemented data. Costs and effects of the situations with and without PO screening were compared for a cohort of 100,000 newborns. Mean screening time per newborn was 4.9 min per measurement and 3.8 min for informing parents. The additional costs of screening were in total €14.71 per screened newborn (€11.00 personnel, €3.71 equipment costs). Total additional costs of screening and referral were €1,670,000 per 100,000 infants. This resulted in an incremental cost-effectiveness ratio of €139,000 per additional newborn with CCHD detected with PO, when compared to a situation without PO screening. A willingness-to-pay threshold of €20,000 per gained QALY for screening in the Netherlands makes the screening likely to be cost-effective.Conclusion: PO screening in the Dutch care setting is likely to be cost-effective. What is Known: • Pulse oximetry is increasingly implemented as a screening tool for critical congenital heart defects in newborns.• Previous studies suggest that the screening in cost-effective and in the USA a reduction in infant mortality from critical congenital heart defects was demonstrated. What is New: • This is the first cost-effectiveness analysis for pulse oximetry screening in a setting with screening after home births, with screening at two moments.• Costs of pulse oximetry screening in a setting with hospital and homebirth deliveries were €14.71 and is likely to be cost-effective accordint to Dutch standards.

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“…They concluded that there is a need for a European Consensus on CCDH screening in Europe [18]. Recently, a panel from The European Pulse Oximetry Screening Workgroup investigating pulse oximetry screening for critical congenital heart defects published a European consensus statement that recommended the use of pulse oximetry for the early detection of CCDH in all European countries, using new-generation equipment that is motion tolerant; screening after 6 h of delivery and before discharge from the birth center, preferably within the 24 h after birth; and using two extremities, the right hand and either foot [19]. In addition, guidelines for the management of CCDH have been implemented, including practical aspects and nomograms to facilitate the management of these babies [20].…”

Section: Discussionmentioning

confidence: 99%

Congenital Critical Heart Defect Screening in a Health Area of the Community of Valencia (Spain): A Prospective Observational Study

Cubells

Torres

Núñez-Ramiro

et al. 2018

IJNS

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Despite the progress in the fetal echocardiographic detection of congenital critical heart defects and neonatal physical examination, a significant number of newborn infants are discharged and readmitted to the hospital in severe condition due to cardiac failure or collapse. The aim of this study was to assess the incidence of undetected critical congenital heart disease (CCHD) by a pulse oximetry-screening program in the maternity wards of hospitals with Perinatal Services in a specific geographic area. This is a prospective observational study performed in in the health area corresponding to the city of Valencia. Eligible infants were consecutively admitted newborn infants in the maternities of the participating hospitals with negative fetal echocardiography after normal physical examination in the delivery room. All patients were screened following a specific pulse oximetry protocol before discharge. A total of 8856 newborn infants were screened. A total of three babies presented with severe congenital cardiac malformation and two babies presented with early onset sepsis. Sensitivity was 100% and specificity was 99.97%, with a positive predictive value of 60% and negative predictive value of 100%. Pulse oximetry screening programs in the early neonatal period constitute a valuable tool to avoid inadvertent hospital discharge of severe cardiac malformations and the subsequent life-threatening complications derived.

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Pulse oximetry screening for critical congenital heart defects: a European consensus statement

Cited by 41 publications

References 11 publications

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

Congenital Critical Heart Defect Screening in a Health Area of the Community of Valencia (Spain): A Prospective Observational Study

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