Pulse oximetry screening for critical congenital heart disease: a comparative study of cohorts over 11 years.

Background: Pulse oximetry (POS) has been proposed as a screening tool for CCHD in newborn. The aim was to identify the effect of POS on the rate of diagnosis after discharge and survival to one year in cases with CCHD.Material and Methods: All cases of CCHD from three tertiary level hospitals in the Northern region of UK between 1st January 2001 and 31st December 2011 were identified from the Northern Congenital Abnormality Survey (NorCAS). A retrospective cohort study comparing screened and unscreened population for CCHD was undertaken. The main outcome was post discharge diagnosis rate and mortality at one year between the cohorts.Results: Total number of births during the 11 years was 138,176. A total of 147 cases had CCHD, 59 diagnosed postnatally. Five and eight cases were diagnosed after discharge in the screened and the unscreened cohort respectively. The rate of post-discharge diagnosis in the screened population was 7/100,000 and 13/100,000 in the unscreened population with a relative risk of 0.52 (CI 0.2 to 1.42). Mortality at one year in postnatally diagnosed cases was five and one in the screened and unscreened cohorts respectively.Conclusion: With good antenatal detection rates, POS did not have a statistically significant impact in identifying cases of CCHD, when added to the present screening process of antenatal ultrasound and postnatal examination. The same conclusion cannot be made for regions with lower antenatal detection rates; perhaps it may be more appropriate to consider pulse oximetry as a screening tool for hypoxemia of any cause.Brief rationaleThis is the first study evaluating the contemporaneous post-discharge diagnosis rate between screened and unscreened populations. The rate of post-discharge diagnosis was 7/100,000 in the screened and 13/100,000 in the unscreened populations. However, this did not achieve statistical significance and in a setting with high antenatal diagnosis a very large study would be required to demonstrate efficacy of POS.

Intrapartum antibiotics for prolonged rupture of membranes at term to prevent Group B Streptococcal sepsis.

The timely administration of intrapartum antibiotic prophylaxis (IAP) to eligible pregnant mothers reduces the risk of early onset Group B Streptococcus (GBS) neonatal sepsis. The incidence of neonatal GBS sepsis is increasing, in spite of national guidelines for its prevention. This retrospective cohort study was undertaken to assess the incidence of culture-proven GBS sepsis before and after a change of practice on intrapartum management of GBS sepsis in babies born at Sunderland Royal Hospital between January 1 2008 and December 31 2017. The data regarding the risk factors, the intrapartum antibiotic prophylaxis and the outcomes of the babies were collected. Twenty-nine cases were identified and presented in two epochs-before and after changing guidelines for intrapartum management. There was a statistically significant reduction in early onset sepsis rates and no difference in late-onset sepsis rates. The prolonged rupture of membranes is a significant risk factor at any gestation. Impact statement What is already known on this subject? Appropriate intrapartum administration of antibiotics in mothers reduces 80% of early-onset GBS infections. In the United Kingdom, IAP is given based on risk factors, which fail to accurately identify and treat the woman who harbours GBS in the birth canal in labour and the incidence of GBS neonatal sepsis is increasing. The national guideline on the prevention of GBS sepsis is not consistent and is open to interpretation. What do the results of this study add? This study highlights prolonged rupture of membranes as a significant risk factor at any gestation and there were missed opportunities to prevent GBS sepsis in term babies with the prolonged rupture of membranes. This study also highlights that it is possible to reduce the neonatal GBS sepsis burden by adhering to guidelines and administering timely intrapartum antibiotics. What are the implications of these findings for clinical practice and/or further research? The timely administration of IAP to all eligible women is possible if the national guidelines are consistent and interpreted correctly. Our national guideline on the prolonged rupture of membranes at term is not clear and is interpreted differently. If IAP is provided in all those with risk factors irrespective of gestation, this would involve additional costs to the NHS; but in the long term, it will benefit as it reduces morbidity.

Vein of Galen malformation presenting as persistent pulmonary hypertension of newborn (PPHN).

Arteriovenous malformation is a recognised cause of persistent pulmonary hypertension in a newborn (PPHN). Vein of Galen malformation (VOGM) is a rare vascular malformation which can be life-threatening if not diagnosed and treated early. We describe a case of a term baby who presented at day 4 of life with PPHN secondary to VOGM. The neonate underwent two transarterial interventional embolisation procedures on day 9 and then another one due to developing ventricular dilation on day 44. He remains stable since and was doing well at clinical review at 10 weeks and 4 months of age. VOGM usually presents in the neonatal period with high-output cardiac failure. In a baby who presents atypically with pulmonary hypertension, a cranial ultrasound scan should be considered to look for extracardiac shunting in the brain, especially, VOGM.

Neonatal screening for critical cardiovascular anomalies using pulse oximetry.

INTRODUCTION: Babies with cardiac anomalies are often asymptomatic at birth, and many remain undetected despite routine newborn examination. We retrospectively assessed the effect of routine pulse oximetry in detection of such anomalies from a hospital birth population of 31 946 babies born between 1 April 1999 and 31 March 2009. METHOD: 29 925 babies who were not admitted to the neonatal unit at birth underwent postductal oxygen saturation measurement before discharge. If saturation was below 95% an examination was performed. If this was abnormal or saturation remained low, an echocardiogram was performed. All babies with cardiac anomaly diagnosed before 1-year were identified from the region's fetal abnormality database. RESULTS: Critical anomalies affected 27 infants (1 in 1180); 10 identified prenatally, 2 after echocardiogram was performed because of other anomalies, 2 in preterm infants, 2 when symptomatic before screening, 5 by oximetry screening, 1 when symptomatic in hospital after a normal screen and 5 after discharge home. Serious anomalies affected 50 infants (1 in 640); 8 identified antenatally, 7 because of other anomalies, 3 in the neonatal unit, 5 by pulse oximetry screening, 11 by routine newborn examination, and 16 after discharge home. CONCLUSIONS: Routine pulse oximetry aided detection of 5/27 of critical and 5/50 of serious anomalies in this sample, but did not prevent five babies with critical and 15 with serious anomalies being discharged undiagnosed. Results from screening over 250 000 babies have now been published, but this total includes only 49 babies with transposition, and even smaller numbers of rarer anomalies.