Critical congenital heart defects occur in around two in 1,000 babies, and are a leading cause of infant death. A quick diagnosis is crucial for the best outcome for these children, but current methods only identify 35-50% of affected babies before birth, and those sent home before diagnosis may become unwell or die. Low blood oxygen levels can, however, be non-invasively detected by pulse oximetry, a simple sensor placed on newborn babies.
In 2007, Dr Andrew Ewer led the PulseOx study, assessing the accuracy of this technique for screening critical congenital heart defects in newborn babies. The study demonstrated the value of pulse oximetry in terms of accuracy, cost-effectiveness and acceptability to patients, resulting in 92% of babies with defects being detected prior to discharge. The work has had major impacts on international policy and practice, as well as for affected children and their parents.
Duration: 3.23mins
Speakers
S1 Dr Andrew Ewer, Reader in Neonatal Paediatrics, College of Medical and Dental Sciences
Transcript
Heart conditions, critical heart conditions, can be picked up normally in one of two ways. Sometimes they can be identified before the babies are born by absolutely antenatal ultrasound scan and sometimes they can be picked up after birth by a physical examination. Now both of these tests have been used for some time but they’re not particularly accurate. For example, the pick-up rate for heart defects with antenatal ultrasound is less than 50% and there’s a great variability across the country, so some hospitals are better at it than others.
So we wanted to identify a new way of picking up these babies and we use a machine called a pulse oximeter. We undertook a study here in the West Midlands which involved six maternity hospital around Birmingham and the West Midlands and we screened over 20,000 babies in just under a year using a pulse oximeter machine. What we found was that within that 20,000 babies there are about 26 who had a critical heart defect and we identified three quarters of those babies by pulse oximetry alone and when we added pulse oximetry to existing screening methods we picked up 92% of all babies, which is far and away a much greater percentage than would be picked up with existing screening methods alone. So this pulse oximetry adds value to existing tests and because of the simple nature of it, could be rapidly and easily rolled out across the whole country. Following on from our study we presented our data to the US health department because they were interested in introducing this type of screening across the United States and our data was used as part of that decision making process and in 2011 the US Health Secretary recommended pulse oximetry screening to be introduced across the states and here we are at the end of 2014 and currently almost 80% of all babies in the United States are being screened by this method and our results were described by one of the leaders of that process as ‘tipping balance towards the introduction of screening in the United States’. Here in the UK we’ve also been pushing for routine screening of all babies and the National Screening Committee held a public consultation at the end of 2013 and in May of this year recommended that pulse oximetry screening be piloted across certain hospitals within the UK with a view to a roll-out across the country and that pilot is starting in January of 2015. So I’m very heavily involved with the set-up of that pilot study and I’m very excited about what that might mean for babies in the UK in the future. Hopefully this test will be introduced in the very near future. I believe it will save lives and I hope that I’m proved right.