The quick and painless pulse oximetry screening test can help detect whether there is enough oxygen in a newborn baby’s blood.
Reasons for lack of oxygen include heart defects as well as problems with lungs, infections or brain function. A baby with a serious condition may be at significant risk of disability or even death if not diagnosed soon after birth.
The UK National Screening Committee (UK NSC) supported a pilot in England in order to understand how doing the pulse oximetry screening test on all newborn babies would work in the NHS. This took place from July to December 2015 and was led by myself as pilot project lead, NIPE national programme manager Jill Walker and clinical advisor Professor Andy Ewer.
The pilot aimed to:
- understand the impact of implementing newborn pulse oximetry screening on NHS services
- find out if it is feasible to roll out newborn pulse oximetry screening in England
We developed a newborn pulse oximetry pilot screening pathway and 15 trusts from across England participated. Of these:
- 7 were already performing pulse oximetry and, where possible, these changed to the pilot pathway
- 8 introduced pulse oximetry as a new screening test using the agreed screening pathway
All worked incredibly hard to implement changes required as part of the pilot and their input and enthusiasm was much appreciated.
Trusts involved in the pilot were given support, including:
- equipment to undertake the screen
- tools to ensure that the data submitted was complete
- a suite of educational resources, including a training film and information for health care professionals to help with local training
- information resources for parents
Trusts reported that the pulse oximetry screening test was very well received by parents during the pilot period.
During the pilot nearly 33,000 newborn babies were screened. 99.3% of babies screened in the pilot had a normal screening result.
The screening test was carried out by midwives, neonatal nurses, hearing screeners, maternity care assistants, nursery nurses and doctors. Most results were recorded on the NIPE SMART IT system.
Summary of headline pilot data
| Pulse oximetry screens performed | 32,836 (complete screens) |
| Babies with normal oxygen levels (screen negative cases) | 32,597 |
| Babies with abnormal oxygen levels (screen positive cases) | 239 |
| Critical congenital heart disease (CCHD) cases identified | 8 |
| Babies with CCHD missed by pulse oximetry screening | 2 |
CCHD conditions detected included critical pulmonary stenosis, transposition of the great arteries, hypoplastic left heart syndrome and coarctation of the aorta. In addition, babies with non-cardiac conditions (such as breathing problems or infections) were also detected.
We submitted the data and other findings from the pilot to the UK National Screening Committee in June 2016. The committee considered that the work showed that it was feasible to screen for critical congenital heart disease using the screening test. However the vast majority of babies with low oxygen levels did not have heart disease. Of these:
- around half did not have any problem at all: these babies had normal circulation but adapted to being born a little more slowly than the majority of babies
- around half did have clinical problems but overwhelmingly these were not heart disease
The work done in the pilot (and published research) did not enable the committee to form a view whether screening did more good than harm for these babies. As these are the majority of screen positive babies it is important to be sure. This is because a pulse oximetry screening programme would divert NHS staff from their usual activities to look after these screen positive babies. If there is no or little benefit to those babies it would be a waste of resources and might affect care for more needy babies.
In discussion with research colleagues the committee decided it would not be possible to do more research but to work with doctors, nurses and parents to understand these issues in more detail. This work is now under way. The UK NSC will consider all the evidence and then make a final recommendation as to whether or not pulse oximetry screening should be offered across the country.
We have supplied trusts with data summaries throughout the pilot. We are now working on a more detailed summary report to share with the participating trusts. The pilot screening pathway is available on request from the PHE screening helpdesk.
We'd like to thank all 15 trusts that took part in the pilot. These were:
- Bradford Teaching Hospitals NHS Foundation Trust
- Brighton and Sussex University Hospitals NHS Trust
- Cambridge University Hospitals NHS Foundation Trust
- Countess of Chester Hospital NHS Foundation Trust
- East Cheshire NHS Trust
- Hull & East Yorkshire Hospitals NHS Trust
- Liverpool Women's NHS Foundation Trust
- Norfolk & Norwich University Hospitals NHS Foundation Trust
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
- The Royal Wolverhampton Hospitals NHS Trust
- United Lincolnshire Hospitals NHS Trust
- University Hospitals of Leicester
- Warrington and Halton Hospitals NHS Foundation Trust
- Wye Valley NHS Trust
- York Teaching Hospital NHS Foundation Trust
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4 comments
Comment by Dr Ali Bokhari posted on
Please can we have a further update on whether the committee is definitely recommending pulse ox is to be used by all to detect CCHD or not. As it is it’s been implemented piece meal and without a definite recommendation and also without a full economic and service evaluation.
Comment by Jill Walker posted on
Thank you for your question.
The UK National Screening Committee decided at its meeting in June 2016 that following the pilot it was important to carefully consider the balance of risks and benefits for the screen positive babies who did not have Critical Congenital Heart Disease (CCHD). The UK NSC’s opinion was that it could only consider introducing routine newborn pulse oximetry screening after investigating these important issues.
Evaluation work has taken place to understand whether these ‘extra screen positive’ babies get more benefit than harm from screening, and to assess the additional impact on NHS services of caring for these babies. In addition, a meeting of clinical experts took place on 22 June 2018 to assess the balance of clinical benefit versus harm for the other conditions (not CCHD) identified as part of the pilot (such as sepsis, congenital pneumonia and transitional circulation).
The outcomes of this meeting are now being written up and the UK NSC will then consider all the available evidence and make a recommendation whether or not to roll out newborn pulse oximetry screening across England. It is likely this will be considered at the UK NSC's late 2018/early 2019 meeting but the exact timescale has yet to be set.
In the meantime we are releasing the original pulse oximetry pilot screening pathway to any trust interested in using it in the interim.
Comment by Jade Jones posted on
This pulse ox test must be made compulsory in all hospitals accross the country! My baby had respiratory problems and would not of been detected if it wasn't for this test!!! So so important
Comment by Jill Walker posted on
Thank you for your comment. Following the newborn pulse oximetry screening pilot study, an economic evaluation is now under way. Once this work has reported, the UK National Screening Committee will then consider all the additional evidence and make a final recommendation as to whether or not pulse oximetry screening should be offered across England.