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Newborn Pulse Oximetry for Infants Born Out-of-Hospital
Pediatrics ( IF 8 ) Pub Date : 2021-10-01 , DOI: 10.1542/peds.2020-048785
Katie B Williams 1, 2 , Michael Horst 3 , Erika A Hollinger 1, 4 , Jacob Freedman 1, 5, 6 , Matthew M Demczko 1, 7 , Devyani Chowdhury 8, 9
Affiliation  

BACKGROUND AND OBJECTIVES

Conventional timing of newborn pulse oximetry screening is not ideal for infants born out-of-hospital. We implemented a newborn pulse oximetry screen to align with typical midwifery care and measure its efficacy at detecting critical congenital heart disease.

METHODS

Cohort study of expectant mothers and infants mainly from the Amish and Mennonite (Plain) communities with limited prenatal ultrasound use. Newborns were screened at 1 to 4 hours of life ("early screen") and 24 to 48 hours of life ("late screen"). Newborns were followed up to 6 weeks after delivery to report outcomes. Early screen, late screen, and combined results were analyzed on the basis of strict algorithm interpretation ("algorithm") and the midwife’s interpretation in the field ("field") because these did not correspond in all cases.

RESULTS

Pulse oximetry screening in 3019 newborns (85% Plain; 50% male; 43% with a prenatal ultrasound) detected critical congenital heart disease in 3 infants. Sensitivity of combined early and late screen was 66.7% (95% confidence interval [CI] 9.4% to 99.2%) for algorithm interpretation and 100% (95% CI 29.2% to 100%) for field interpretation. Positive predictive value was similar for the field interpretation (8.8%; 95% CI 1.9% to 23.7%) and algorithm interpretation (5.4%; 95% CI 0.7% to 18.2%). False-positive rates were ≤1.2% for both algorithm and field interpretations. Other pathologies (noncritical congenital heart disease, pulmonary issues, or infection) were reported in 12 of the false-positive cases.

CONCLUSIONS

Newborn pulse oximetry can be adapted to the out-of-hospital setting without compromising sensitivity or prohibitively increasing false-positive rates.



中文翻译:

院外出生婴儿的新生儿脉搏血氧饱和度测定

背景和目标

新生儿脉搏血氧饱和度筛查的常规时间对于院外出生的婴儿并不理想。我们实施了新生儿脉搏血氧饱和度屏幕,以符合典型的助产士护理,并测量其在检测严重先天性心脏病方面的功效。

方法

主要来自阿米什人和门诺派(平原)社区的孕妇和婴儿的队列研究,产前超声使用有限。新生儿在出生后 1 至 4 小时(“早期筛查”)和出生后 24 至 48 小时(“晚期筛查”)进行筛查。新生儿在分娩后最多随访 6 周以报告结果。在严格的算法解释(“算法”)和现场助产士的解释(“现场”)的基础上对早期筛查、晚期筛查和组合结果进行分析,因为它们并非在所有情况下都对应。

结果

对 3019 名新生儿(85% 为普通新生儿;50% 为男性;43% 使用产前超声检查)进行脉搏血氧饱和度筛查,在 3 名婴儿中检测到严重的先天性心脏病。联合早期和晚期筛查的敏感性为算法解释的 66.7%(95% 置信区间 [CI] 9.4% 至 99.2%)和现场解释的 100%(95% CI 29.2% 至 100%)。现场解释(8.8%;95% CI 1.9% 至 23.7%)和算法解释(5.4%;95% CI 0.7% 至 18.2%)的阳性预测值相似。算法和现场解释的假阳性率均≤1.2%。在 12 例假阳性病例中报告了其他病理(非严重先天性心脏病、肺部问题或感染)。

结论

新生儿脉搏血氧饱和度可以适应院外环境,而不会影响灵敏度或增加假阳性率。

更新日期:2021-10-01
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