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All babies in Europe should be screened for heart defects at birth

Only a few countries, including Poland, Ireland and Switzerland, currently recommend universal screening with pulse oximetry

Ingrid Torjesen

Wednesday, 08 November 2017

All babies born in Europe should be routinely screened with pulse oximetry for critical congenital heart defects (CCHD) within 24 hours of birth, says a group of neonatologists and paediatric cardiologists called the European Pulse Oximetry Screening Workgroup (EPOSW).

CCHD occur in around two in every 1,000 newborn babies, and are a leading cause of infant death. Timely diagnosis is crucial for the best outcome, but current screening methods may miss up to 50% of affected newborn infants, and those sent home before diagnosis frequently die or suffer major morbidity.

However, babies with CCHD often have low blood oxygen levels which can be detected quickly and non-invasively by pulse oximetry screening (POS), using a simple sensor placed on newborn infants' hand and foot. This medical device monitors the oxygen saturation of a patient's blood through their skin, as opposed to measuring oxygen levels directly through a blood sample.

EPOSW has published a consensus statement1 in The Lancet Child Adolescent Health calling for pulse oximetry screening for all babies across Europe after six hours of life or before discharge - preferably within 24 hours of birth.

The recommendations follow the PulseOx study2 led by a team from University of Birmingham and Birmingham Women's Hospital in 2011 which screened over 20,000 newborn babies for critical heart defects using POS. This study, and an important meta-analysis3 of the test published by the same team in 2012, has led to POS being used by an increasing number of hospitals in the UK and Europe. However, to date, only a few countries such as Poland, Ireland and Switzerland have issued national guidelines recommending universal screening with pulse oximetry.

Senior author Professor Andrew Ewer, of the Institute of Metabolism and Systems Research at the University of Birmingham, said: "These recommendations are the culmination of almost a decade's work driven by one focus; to prevent as many babies as possible from dying as a result of undetected heart defects. Surgical and catheter interventions for CCHD now lead to excellent outcomes for most cases of CCHD, but timely detection is essential.”

He added: "We have tried to create common, shared, flexible, and evidence-based recommendations for use and standardisation of POS for early detection of CCHD across Europe. These recommendations should be considered at a national level as an approach to better identify CCHD, and other life-threatening conditions, in newborn babies."

The UK National Screening Committee is currently considering the evidence for POS and whether it should be introduced to the UK national screening programme.

  1. Manzonia P, Martin GR, Sanchez Luna M, et al. Pulse oximetry screening for critical congenital heart defects: a European consensus statement. The Lancet Child & Adolescent Health, Volume 1, Issue 2, October 2017, Pages 88-90. DOI: 10.1016/S2352-4642(17)30066-4
  2. Ewer AK, Middleton LJ, Furmston AT, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. The Lancet, published: 05 August 2011. DOI: 10.1016/S0140-6736(11)60753-8
  3. Thangaratinam S, Brown K, Zamora J, et al. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. The Lancet, published: 02 May 2012. DOI: 10.1016/S0140-6736(12)60107-X

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