Texas Pulse Oximetry Project: A Multicenter Educational and Quality Improvement Project for Implementation of Critical Congenital Heart Disease Screening Using Pulse Oximetry

Abstract

Critical congenital heart disease (CCHD) is a leading cause of death in infants. Newborn screening (NBS) by pulse oximetry allows early identification of CCHD in asymptomatic newborns. To improve readiness of hospital neonatal birthing facilities for mandatory screening in Texas, an educational and quality improvement (QI) project was piloted to identify an implementation strategy for CCHD NBS in a range of birthing hospitals. Thirteen Texas hospitals implemented standardized CCHD screening by pulse oximetry. An educational program was devised and a tool kit was created to facilitate education and implementation. Newborn nursery nurses' knowledge was assessed using a pre- and posttest instrument. The nurses' knowledge assessment improved from 71 to 92.5% ( < 0.0001). Of 11,322 asymptomatic newborns screened after 24 hours of age, 11 had a positive screen, with 1 confirmed case of CCHD. Pulse oximetry CCHD NBS had sensitivity of 100%, specificity of 99.91%, false-positive rate of 0.088%, positive predictive value of 9.09%, and negative predictive value of 100%. Our educational program, including a tool kit, QI processes, and standardized pulse oximetry CCHD NBS, is applicable for a range of hospital birthing facilities and may facilitate wide-scale implementation, thereby improving newborn health.

Pulse oximetry test for screening congenital heart diseases: a systematic review

“…There was a plurality in terms of study countries, demonstrating the divergences in the protocols followed, with the United States (21,23,25,28,32,35,47) and United Kingdom (30,(40)(41)(42)(43) being the countries with the most publications. As for the sample, it varied in the size of the studies.…”

“…Subsequently, subgroup analyses were carried out for sensitivity and specificity, according to the time of birth and the first POT measurement between 24 and 48 hours (Figures S1 and S2). In this meta-analysis, 20 studies were included (21)(22)(23)(24)27,28,(31)(32)(33)(35)(36)(37)(38)(40)(41)(42)(44)(45)(46)(47)(48) with a sample of 203,992 participants. An increase in sensitivity to 67% (95% CI: 62% to 72%) and specificity to 97% (95% CI: 97% to 97) was demonstrated.…”

“…A third analysis including studies that were carried out with protocols that contained retests after the first measurement, comprising 13 studies (21,24,27,28,31,32,34,35,37,38,42,44,45) and a sample of 124,469 participants was also developed (Figures S3 and S4). In this analysis, there was a similar increase in sensitivity to 91% (95% CI: 85% to 95%) and specificity to 100% (95% CI: 100% to 100%).…”

“…<94%: assessment by a pediatric cardiologist. Furthermore, there were studies that performed retests over a period of time greater than one hour and up to two hours, including eight studies (21,23,28,31,32,35,37,41) and a total sample of 27,473 participants (Figures S7 and S8). In this case, sensitivity was 76% (95% CI: 65% to 84%) and specificity was 99% (95% CI: 99% to 99%).…”

The ‘Ironclad friendship’ of China-Cambodia, lays the first step in the foundation of early diagnosis and treatment of asymptomatic congenital heart Defects- A multi-national screening and intervention project, 2017–2020

“…ultrasound) and neonatal (e.g. pulse oximetry) CHD screenings tests focus on critical CHD [ 24 – 26 ]. Moreover, the prevalence of CHD was higher in less developed areas, indicating a higher misdiagnosis rate, which may be attributed to the lack of skilled personnel and advanced facilities for diagnosis and treatment [ 27 – 28 ],as well as parents’ willingness to undergo early CHD screening.Considerable evidence indicates that in the majority of developing countries, achieving the goal of early diagnosis and treatment remains a challenge, which significantly hampers overall population development [ 28 – 30 ].…”