title: Pulse Oximetry Screening for Critical Congenital Heart Disease after Home Birth and Early Discharge.
abstract: OBJECTIVE
  To assess the feasibility of pulse oximetry (PO) screening in settings with home births and very early discharge. We assessed this with an adapted protocol in The Netherlands.
  
  
  METHODS
  PO screening was performed in the Leiden region in hospitals and by community midwives. Measurements were taken ≥ 1 hour after birth and on day 2 or 3 during the midwife visit. Primary outcome was the percentage of screened infants with parental consent. The time point of screening, oxygen saturation, false positive (FP) screenings, critical congenital heart defects (CCHDs), and other detected pathology were registered.
  
  
  RESULTS
  In a 1-year period, 3625 eligible infants were born. Parents of 491 infants were not approached for consent, and 44 refused the screening. PO screening was performed in 3059/3090 (99%) infants with obtained consent. Median (IQR) time points of the first and second screening were 1.8 (1.3-2.8) and 37 (27-47) hours after birth. In 394 infants with screening within 1 hour after birth, the median pre- and postductal oxygen saturations were 99% (98%-100%) and 99% (97%-100%). No CCHD was detected. The FP prevalence was 1.0% overall (0.6% in the first hours after birth). After referral, important noncritical cardiac and other noncardiac pathology was found in 62% of the FP screenings.
  
  
  CONCLUSIONS
  PO screening for CCHD is feasible after home births and very early discharge from hospital. Important neonatal pathology was detected at an early stage, potentially increasing the safety of home births and early discharge policy.
authors.affiliation: Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: i.c.narayen@lumc.nl.
authors.forename: Ilona C
authors.initials: IC
authors.lastname: Narayen
authors.affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nico A
authors.initials: NA
authors.lastname: Blom
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marjolein S
authors.initials: MS
authors.lastname: Bourgonje
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Monique C
authors.initials: MC
authors.lastname: Haak
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marrit
authors.initials: M
authors.lastname: Smit
authors.affiliation: Cooperation of Community Midwives in the Leiden Region (LEO), Leiden, The Netherlands.
authors.forename: Fennie
authors.initials: F
authors.lastname: Posthumus
authors.affiliation: Department of Pediatrics, Alrijne Hospital, Leiden, The Netherlands.
authors.forename: Annique J M
authors.initials: AJ
authors.lastname: van den Broek
authors.affiliation: Department of Pediatrics, Alrijne Hospital, Leiderdorp, The Netherlands.
authors.forename: Hester M
authors.initials: HM
authors.lastname: Havers
authors.affiliation: Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006700:Home Childbirth; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis; D007231:Infant, Newborn; D007239:Infections / Q000175:diagnosis; D008471:Meconium Aspiration Syndrome / Q000175:diagnosis; D008880:Midwifery; D009426:Netherlands; D010092:Oximetry / Q000706:statistics & numerical data*; D010100:Oxygen / Q000097:blood; D033282:Parental Consent / Q000706:statistics & numerical data; D010351:Patient Discharge; D011086:Polycythemia / Q000175:diagnosis; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D010100:Oxygen