ABSTRACT
Background. Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world.Objectives. To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital; a busy government hospital in Cape Town; South Africa. Parent and staff acceptance was assessed.Methods. We conducted a prospective study of predischarge POx screening in one postnatal ward; following informed parental consent.Results. During the 4-month study period; 1 017 of 2 256 babies discharged (45.1%) were offered POx screening and 1 001 were screened; 94.0% of tests took 3 minutes to perform; 4.3% 3 - 5 minutes and 1.7% 5 minutes. Eighteen patients needed second screens and three required third screens. Only 3.1% protocol errors were made; all without consequence. The vast majority (91.6%) of nursing staff reported insufficient time to perform the study screening in addition to their daily tasks; but ~75% felt that with a full nursing staff complement and if done routinely (not part of a study); pre-discharge POx screening could be successfully instituted at our facility. Over 98% of the mothers had positive comments. Two babies failed screening and required echocardiograms; one was diagnosed with CCHD and the other with neonatal sepsis. The sensitivity and specificity were 50% (95% confidence interval (CI) 1.3 - 98.7%) and 99.9% (95% CI 99.4 - 100%); respectively; with a percentage correct of 99.8%.Conclusions. POx screening was supported and accepted by staff and parents. If there are no nursing staff shortages and if it is done routinely before discharge; not as part of a study; we conclude that POx screening could be implemented successfully without excessive false positives or errors; or any additional burden to cardiology services
Subject(s)
Hospitals , Infant , Infant, Newborn , Neonatal Screening , OximetryABSTRACT
South Africa continues to face unacceptably high rates of rheumatic fever (RF) and rheumatic heart disease (RHD); despite readily available and inexpensive preventive measures. However; in the past several years; key players in South Africa's healthcare and political realms in addition to key players from many African nations have come together to acknowledge the persistent health burden attributable to RF/RHD and have agreed to a pledge of action to reduce it.The plan of action is a comprehensive RF/RHD prevention and treatment programme known as ASAP. The ASAP programme targets efforts to raise Awareness; establish surveillance systems; Advocate for increased resources for treatment; and to promote Prevention strategies. South Africa currently has a demonstration site where activities in all of these key areas are currently underway. Efforts in the area of surveillance include a RHD prevalence study that aims to screen 4 000 school-aged children through the use of a mobile echo-surveillance unit. In addition to local efforts; South Africa will join an international initiative to create a global RHD registry that will aid in all aspects of prevention and treatment to further reduce the burden of disease attributable to RF/RHD