Pulse oximetry screening for congenital heart defects

856 www.thelancet.com Vol 382 September 7, 2013 screening did not discuss CCHD screening. However, in Switzerland and Sweden most infants are now screened with pulse oximetry, and the Royal College of Physicians of Ireland has recommended screening. In the UK, approximately 20% of maternity units use pulse oximetry screening; Nordic countries are surveying implementation but its use in the rest of Europe is unknown. In June, 2013, an international group of neonatologists and cardiologists met in Turin, Italy, with the chief investigators from two European screening studies of pulse oximetry (AKE, AD-WG), to discuss strategies to develop Europe-wide recommendations for CCHD screening. Members of the group included a leader in US CCHD implementation (GRM), and chair and board members of international and European neonatology societies (PM, MSL). The discussion confirmed that the evidence for CCHD screening was suffi ciently robust to consider European implementation, but concern arose over the wide variation in routine maternity care (eg, antenatal detection rates of CCHD and length of stay after delivery) and the impact of screening on clinical services. Additional barriers identifi ed included increasing trends for home births, cost of implementation (staff and equipment costs), and management of test positives (neonatal admissions and echocardiography). Evidence suggests that routine CCHD screening is cost-eff ective. Additional benefi ts (eg, giving confi dence to allow earlier discharge and identifi cation of non-cardiac conditions) might further improve cost-effectiveness, but need careful consideration by individual countries. The group concluded that the maxim that no newborn baby should have unexplained persistent hypoxaemia and be discharged home is true. The importance of detection of babies with CCHD before acute collapse is clear, because existing screening methods still miss up to 30% of cases; the addition of pulse oximetry screening Jeanette Teo, Sean Yang-Yi Tan, Martin Tay, Yichen Ding, Staff an Kjelleberg, Michael Givskov, Raymond T P Lin, *Liang Yang yangliang@ntu.edu.sg