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The problem
Congenital heart defects (CHD) are the most common congenital anomaly and range from asymptomatic to lethal.1 2 Early recognition is critical to prevent postnatal collapse as CHD account for nearly 10% of neonatal deaths.1
At birth every newborn undergoes major physiological adaptation including the closure of the ductus arteriosus. In a structurally normal heart these changes are required for optimal oxygenation of peripheral tissues. However, closure of these shunts can be lethal in newborns with duct-dependent cardiac conditions. If detected early, prostaglandin infusion can be used to maintain patency of the ductus arteriosus until surgery is performed.3
Antenatal ultrasound screening does not detect all structural heart defects, missing approximately half of cases.4 5 Current UK screening committee guidelines offer all babies a newborn and infant physical examination (NIPE).6 However, this will still miss a further estimated 55% of cases.7
Multiple studies including a Cochrane review have shown that preductal and postductal saturation screening in newborns increases the detection of critical CHD8–10 and is generally acceptable to parents.11
Aims
Implement universal preductal and postductal saturation screening in babies born under the care of the West Suffolk maternity team (hospital and home births).
Evaluate the number of babies referred to the neonatal team for review due to abnormal screening.
Review any cases of CHD detected via screening.
Making a case for change
Following the death of two babies from CHD, the screening was driven by a paediatric consultant with support from Professor Ewer who led the PulseOx study.8 Discussions at governance meetings and case presentations resulted in the formation of a multidisciplinary team including doctors, midwives and neonatal nurses.
Your improvements
This quality improvement project began on 9 August …
Footnotes
ESR and SML are joint first authors.
ESR and SML contributed equally.
Contributors ESR and MN designed the study. ESR, KR, AC, JB and SML implemented changes and coordinated educational events. ESR, SML and HS collected data. SML performed statistical analysis. SML wrote the manuscript. MN and ESR contributed to the manuscript preparation.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.