Pulse oximetry findings in newborns with antenatally diagnosed congenital heart disease.

A retrospective review of admission preductal oxygen saturations of neonates with antenatally diagnosed critical congenital heart disease (CCHD) was performed to investigate the differences in newborn pulse oximetry (Pulsox) by specific CCHD diagnosis. Saturations were recorded at median of < 1 h (range < 1-9 h) after delivery. Data was stratified by CCHD diagnosis and analysed according to the three different admission Pulsox thresholds, ≤ 90, ≤ 92 and ≤ 95%. Of the 276 neonates studied, 208 were clinically well at admission, with no co-morbidities, gestation > 34 weeks and birth weight > 1.8 kg. A statistically significant increase in the proportion with low admission saturations was seen using ≤ 95% saturation threshold (72% (95% CI 66-78)) compared to ≤ 92% (52% (95% CI 46-59)) and ≤ 90% (46% (95% CI 39-52)). Sub-group analysis found the proportion of neonates with low saturations varied according to the specific CCHD diagnosis with only 20-42% of neonates with aortic stenosis, coarctation of the aorta and pulmonary stenosis having saturations ≤ 95%. CONCLUSION: The proportion of neonates with low admission oxygen saturation varied by CCHD diagnosis with those without critically reduced pulmonary blood flow not having low admission saturations, in general, even using the ≤ 95% threshold which had the highest proportions of abnormal saturations. This data may assist developing Pulsox screening policies. What is Known: • The addition of pulse oximetry (Pulsox) screening to the routine newborn examination increases the sensitivity of CCHD detection. Pulsox screening is also highly specific for CCHD in asymptomatic neonates, with low false-positive rates. • Early diagnosis of CCHD improves patient outcomes in relation to both morbidity and mortality. What is New: • The proportion of affected infants with an abnormal Pulsox result varies by CCHD diagnosis and screening threshold. In our study using the ≤ 95% threshold gave the highest proportion of neonates with abnormal saturations at admission. • In general, Pulsox yield of abnormal results is low for CCHD diagnoses not associated with critically reduced pulmonary blood flow; however, increasing the Pulsox threshold increased the proportion of infants with an abnormal result.

A comparison of oxygen saturation measurements obtained from a 'blue sensor' with a standard sensor.

AIM: The study aims to investigate pulse oximetry measurements from a 'blue' pulse oximeter sensor against measurements from a 'standard' pulse oximeter sensor in newly born infants. METHODS: Immediately after birth, both sensors were attached to the infant, one to each foot. SpO2 measurements were recorded simultaneously from each sensor for 10 min. Agreement between pairs of SpO2 measurements were calculated using Bland-Altman analysis. RESULTS: Thirty-one infants were studied. There was good correlation between simultaneous SpO2 measurements from both sensors (r² = 0.75). However, the mean difference between 'blue' and 'standard' sensors was -1.6%, with wide 95% limits of agreement +18.4 to -21.6%. The range of mean difference between sensors from each infant ranged from -20 to +20. CONCLUSION: The mean difference between the blue and standard sensor SpO2 measurements is not clinically important.

Predicting risk of underconfidence following maternity leave.

OBJECTIVE: To determine what factors affect paediatric trainee confidence on return to work after maternity leave. DESIGN: Information was collected anonymously via an online survey from trainees who had taken maternity leave. SETTING: The survey was distributed centrally to each UK deanery. MAIN OUTCOME MEASURES: Trainee confidence was rated retrospectively using self-assessment. RESULTS: 146 paediatric trainees from 12 out of 13 deaneries completed the survey. 96% of trainees experienced an initial lack of confidence, with 36% requiring 3 months or longer for their confidence to return. Prolonged lack of confidence was associated with longer time out of training, training stage, returning part-time, less frequent engagement with educational activities and lack of recognition by supervising consultant. CONCLUSION: We propose a scoring system using the above risk factors, the MoTHER score (Months out, Training stage, Hours worked on return, Educational activities, Recognition by consultant), which can be used to identify trainees who are at higher probability of experiencing reduced confidence on return to work.