Routine pulse oximetry in the asymptomatic newborn

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Abstract
Objective: To assess the effect of routine measurement of postductal oxygen saturation as an adjunct to routine clinical examination in the asymptomatic newborn. Design and setting: Prospective study in a district general hospital. Patients: All 6166 infants inborn between 1 April 1999 and 31 March 2001. Intervention: Oxygen saturation was measured over two minutes, after the age of 2 hours and before discharge, in one foot of all babies not admitted directly to the neonatal unit. Babies with fractional (as opposed to functional) oxygen saturation (Sao2) below 95% were examined by the midwife. If this examination was abnormal or if normal but further measurements were below 95%, an echocardiogram was performed. All babies with cardiac malformations diagnosed by 1 year of age were identified from databases maintained at the regional cardiology referral unit and the regional congenital malformation survey. Results: Measurements were made in 98% of eligible babies. A fractional Sao2 less than 95% was found in 5% but persisted in only 1%. Structural cardiac malformations were found in 50 (8.1/1000), 26 of whom had isolated ventricular septal defects. Of the remaining 24 with other cardiac malformations, attention was first drawn to six by low Sao2, and four more, first noticed for other reasons, also had low Sao2. Low Sao2 also first drew attention to 13 other babies ill for other reasons. Conclusion: Newborn babies with important cardiac malformations are often asymptomatic initially and the yield from clinical examination is poor. Measuring postductal saturation routinely in newborn babies before discharge is easy and can alert staff to ill babies.