Routine pulse oximetry is gaining ground

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In recent years, pulse oximetry, a method used to measure the oxygen in the blood, has attracted increasing attention in connection with congenital heart defects. The method seems to have the potential to detect critical congenital heart defects in newborns at an early stage – even before visible symptoms occur. This is of particular significance since earliest possible diagnosis can be crucial for the further course of the disease. Various studies have assessed the examination method in detail.

Calls for the introduction of routine pulse oximetry screening

Experts as well as patients’ and parents’ associations are increasingly calling for routine pulse oximetry screening to be introduced within the scope of standard neonatal examinations.

The clinical practice currently differs between countries worldwide. In Europe, binding national screening programmes are not in force so far. Likewise, uniform standards for the measurement (e.g. time of measurement, positioning of the probe, threshold values) have not yet been drawn up. However, such standards are a precondition for the routine application of the examination method. In some European countries, for example, Switzerland and Poland, official recommendations are meanwhile available.

American states pioneering

Currently, the USA are most advanced. In 2009, the two medical societies, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA), recommended incorporating pulse oximetry into routine neonatal care. Corresponding recommendations on the introduction of standardized pulse oximetry screening, including the criteria for measurements were released in 2011 under the auspices of the AAP. Since then, area-wide pulse oximetry screening in newborns has been introduced in several US states. The remaining states are currently evaluating or planning the introduction of such screening programs (you can observe the current developments in the USA via their website).

Also in Europe, pulse oximetry is increasingly gaining ground. For example, the British Children’s Heart Federation is campaigning for area-wide pulse oximetry screening in all newborns in Great Britain and is collecting signatures for a corresponding petition.

In Germany, the Federal Joint Committee, the highest decision-making body of the joint self-government of physicians, dentists, hospitals and health insurance funds, is currently assessing the option of including pulse oximetry screening to detect critical congenital heart defects in the catalogue of medical care services covered by the compulsory health insurance system. A positive result would mean another step towards the routine use of pulse oximetry also in Germany.

Get more detailed information on the procedure of pulse oximetry here.

References

  • Bundesministerium für Gesundheit (2013). Bekanntmachung des Gemeinsamen Bundesausschusses über weitere Beratungsthemen zur Überprüfung gemäß § 135 Absatz 1 des Fünften Buches Sozialgesetzbuch (SGB V) in Verbindung mit § 26 SGB V: Prüfung des Screenings auf schwere congenitale Herzfehler mittels Pulsoxymetrie Vom 25. April 2013. (aufgerufen am 25.06.2013).
  • Swiss Society of Neonatology (2006). Empfehlungen zum neonatalen Screening kongenitaler Herzfehler. Zürich 2006. (aufgerufen am 11.04.2013).
  • Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman III RH, Grosse SD, on behalf of the American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research; and the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, and Committee on Fetus and Newborn (2009). Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease. A Scientific Statement From the American Heart Association and American Academy of Pediatrics. Circulation;120(5):447-58.
  • De-Wahl Granelli A, Wennergren M, Sandberg K, Mellander M, Bejlum C, Inganäs L, Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunnegårdh J, Verdicchio M, Ostman-Smith I (2009). Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ;338:a3037.
  • Riede FT, Hambsch J, Dähnert I, Schneider P, Janousek J (2009). Kritische angeborene Herzfehler. Pathophysiologische Grundlagen und praktische Hinweise zur Akutdiagnostik und -therapie bei Neugeborenen. Kinder- und Jugendmedizin 3: 133-139. Kostenloser Download. (aufgerufen am 11.04.2012).
  • Riede FT, Wörner C, Dähnert I, Möckel A, Kostelka M, Schneider P (2010). Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine—results from a prospective multicenter study. Eur J Pediatr;169:975–981.
  • Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, Deeks JJ, Khan KS; PulseOx Study Group (2011). Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet;378(9793):785-94.
  • Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson GD, Glidewell J, Grosse SD, Howell RR (2011). Strategies for Implementing Screening for Critical Congenital Heart Disease. Pediatrics;128(5):e1259-67.
  • Section on Cardiology and Cardiac Surgery Executive Committee: Mahle WT, Martin GR, Beekman III RH, Morrow WR, Rosenthal GL, Snyder CS, Minich LL, Mital S, Towbin JA and Tweddell JS (2012). Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatrics;129: 190-2.
  • Turska Kmieć A, Borszewska Kornacka MK, Błaż W, Kawalec W, Zuk M (2012). Early screening for critical congenital heart defects in asymptomatic newborns in Mazovia province: experience of the POLKARD pulse oximetry programme 2006-2008 in Poland. Kardiol Pol;70(4):370-6.
  • Ewer AK (2013). Review of pulse oximetry screening for critical congenital heart defects in newborn infants. Curr Opin Cardiol;28(2):92-96.
  • Shereena K, Mazrouei A, Moore J, Ahmed F, Bradshaw Mikula E, Martin GR (2013). Regional Implementation of Newborn Screening for Critical Congenital Heart Disease Screening in Abu Dhabi. Pediatr Cardiol. 27 March 2013 (online).
Author(s): Eva Niggemeyer
Last updated: 2013-09-03