Purpose: To assess the implementation of neonatal pulse oximetry screening in a tertiary level hospital. 

Methods: A prospective screening study was conducted for all infants admitted to the Term nursery and Neonatal Intensive Care Unit from August 31st, 2011 to August 31st, 2012. Policy mandated measurement of oxygen saturation (SpO2) using pulse oximetry in all infants over 24 hours old or prior to discharge.  Infant measurement probe was applied to the right hand and either foot to obtain pre- and post-ductal SpO2 respectively. A saturation of ≤94% or ≥4% difference between pre- and post-ductal saturation was considered a failed screen and was repeated up to 3 times.  The results of the screen(s) were recorded in the infant’s medical record in the discharge care map.  Parents were informed of the indications and made aware that a pass on the screening does not exclude the existence of a cardiac disorder.

A total of 2053 newborns were screened from 8/31/11 to 8/31/12 out of 2099 live births (2.1% were not screened prior to discharge). Eleven newborns had positive screens that required a cardiology consult and an echocardiogram. Four of these had CCHD, two had serous CHD, and 5 had a false positive screen.  The sensitivity for detecting CHD was 75% (95% CI 34.9-96.8), the specificity was 99.8% (95% CI 99.4- 99.9), positive predictive value was 54.5 (95% CI 23.4-83.3), and negative predictive value was 99.9 (95% CI 99.6-99.99).  False positive and negative rates were 0.2% and 0.1% respectively.

Conclusion: Pulse oximetry is a simple test that can be successfully implemented in a tertiary level hospital without prohibitive financial burden on the hospital, as compared to the potential cost of a missed CCHD diagnosis.