Canadian Paediatricians' Perceptions of Neonatal Pulse Oximetry Screening
CPS ePoster Library. Wong K. Jun 1, 2017; 176614
Kenny Wong
Kenny Wong
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Abstract
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Background: Neonatal pulse oximetry screening (NPOS) has been shown to enhance the detection of Critical Congenital Heart Disease (CCHD) by detecting levels of hypoxemia otherwise undetectable by clinical evaluation. Earlier detection of CCHD decreases morbidity, mortality and disability, with studies estimating that 30% of CCHDs are diagnosed after 3 days of age and 25% of babies are discharged prior to diagnosis. While the American Academy of Pediatrics endorsed NPOS in 2012, the status of screening in Canada is unknown.

Objectives:

Methods: A one-time survey was circulated by CPSP to obtain information about Canadian paediatricians' perceptions of NPOS and the extent to which NPOS is utilized in Canada.

Results: There were 660/2601 responses (25% response rate). 74% of all responders and 83% of general pediatrician responders were aware of NPOS, and 53% of the general paediatrician responders were aware of the AAP NPOS protocol. 26% (135) of the responders were using NPOS. Of the responders who did not screen, 64% (246) supported developing NPOS at their centre, 31% (119) were undecided and <5% (18) were against implementation. When given a list of barriers to developing a NPOS program, the need for a CPS statement (47%), concerns for false positives (54%), and insufficient nursing resources (41%) were the most common reasons selected by the responders. Of the responders with NPOS programs, 11% believed it was part of a provincial program, while for the majority (48%) it was not or was unknown (41%). The arm and foot were tested in 69% of programs with NPOS while 13% of programs checked the foot only. The paediatrician was called for abnormal results in 91% of the protocols. Of the responders, 77% had access to neonatal echocardiography in their centre (54%) or in their city (23%), with similar access to cardiology consultation (46% in their centre, 23% in their city). In the last 2 years, 36% (189) of the responders had been involved in cases of newborns with CCHD who were not detected by prenatal ultrasound or newborn physical examination. Of these, 71% (140) were diagnosed after neonatal discharge and 52% required resuscitation, 12% dying before intervention.

Conclusion: The majority of the responders to this CPSP survey were aware of and supported developing NPOS at their centres while only a small fraction was currently screening. The CPS can play a larger role in helping with the application and adoption of NPOS to enhance detection of CCHD in Canada. 

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