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Guideline
Routine pulse oximetry testing for newborn babies: a framework for practice
  1. Vix Monnelly1,
  2. Thomas McEwan2,
  3. Kate Hannah Regan3,
  4. Lambri Yianni4,
  5. Suzie Hutchinson5,
  6. Jon Arnold6,
  7. Kate Dinwiddy7,
  8. Nicola Brake6,
  9. Jessica Case-Stevens8,
  10. Katie Cullum9,
  11. Kerry Louise Gaskin10,
  12. Olivia Houlihan11,
  13. Caroline B Jones12,
  14. Beth McCleverty13,
  15. Ayevbekpen Grace Okoye14,
  16. Sam J Oddie15,
  17. Ngozi Edi-Osagie16,
  18. Eleri Adams17,
  19. Andrew K Ewer18
  1. 1Simpson Centre for Reproductive Health, Edinburgh, UK
  2. 2NHS Education for Scotland West Region, Glasgow, UK
  3. 3Centre for Inflammation Research, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
  4. 4University Hospital Southampton NHS Foundation Trust, Southampton, UK
  5. 5Little Hearts Matter, Birmingham, UK
  6. 6Tiny Tickers, London, UK
  7. 7British Association of Perinatal Medicine, London, UK
  8. 8Cardiff University, Cardiff, UK
  9. 9East of England Neonatal Operational Delivery Network, Norwich, UK
  10. 10Nursing and Midwifery Department, Birmingham City University–City South Campus, Birmingham, UK
  11. 11Homerton Healthcare NHS Foundation Trust, London, UK
  12. 12Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  13. 13Bliss, London, UK
  14. 14King’s College Hospital, London, UK
  15. 15Bradford Neonatology, Bradford Royal Infirmary, Bradford, UK
  16. 16Manchester University NHS Foundation Trust, Manchester, UK
  17. 17Neonatal Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  18. 18College of Medical Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Andrew K Ewer; a.k.ewer{at}bham.ac.uk

https://doi.org/10.1136/archdischild-2024-328285

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    Executive summary of recommendations

    Background

    • Conditions associated with hypoxaemia (low blood oxygen levels) are important causes of death and morbidity in the neonatal period; detection of mild-to-moderate hypoxaemia by clinical examination alone is unreliable.

    • Pulse oximetry is a non-invasive method of determining blood oxygen levels and routine testing (PulseOx Test) may identify potentially important conditions early.

    • The British Association of Perinatal Medicine (BAPM) recommends routine pulse oximetry testing using a standardised protocol for all asymptomatic newborn babies born at 34 weeks’ gestation and above.

    Protocol for pulse oximetry testing

    • BAPM recommends the same protocol irrespective of birth location. This involves measuring oxygen saturations from two sites; preductal saturation from the right hand and postductal from either foot (figure 1).

    • Saturations of 95% or higher with pre/post difference of 2% or lower are considered acceptable.

    • Testing should ideally be performed in the first 24 hours following birth, and suggested optimal timing is between 4 and 8 hours. There are three possible pathways following the initial test—green, amber and red.

    • Inability or significant difficulty in obtaining either preductal or postductal saturations should not be assumed to be due to equipment/technical difficulties; it may indicate underlying poor perfusion and should trigger an urgent senior review.

    • Most babies on the red pathway (positive result) will have a condition which requires treatment, although up to 20% of babies on the red pathway will be healthy babies—with delayed cardiorespiratory adaptation following birth—who are usually easily identified.

    • Respiratory conditions and infections are the most common causes of low saturations, and initial assessment should look carefully for signs of these and investigate and treat appropriately.

    • Routine echocardiography is not necessary unless a cardiac condition is suspected.

    • Testing should be in addition to newborn examination including the newborn infant physical examination (NIPE) examination and (if appropriate) the newborn early warning track and trigger (NEWTT2).

    • Babies admitted to a …

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    Footnotes

    • X @tom0mcewan, @GaskinKerry, @CarolineCardiac

    • Contributors All authors attended at least one working group meeting and contributed to the writing and editing of the framework for practice. AKE chaired the working group. VM, EA and AKE conceptualised the framework. LY, AGO, VM and AKE wrote the first draft of the Introduction and Background sections. VM and AKE wrote the first draft of The protocol and pathways of care section and VM wrote the first draft of the Management of positive PulseOx Test (red pathway) section. TM, OH and JC-S wrote the first draft of the Home births section. SH, JA and NB wrote the first draft of the Information for parents section. AKE wrote the first draft of the Equipment section and the Accuracy of pulse oximeters in individuals with darker skin tones section. KHR and EA wrote the first draft of the Audit and governance section. All authors contributed significantly to subsequent edits. VM, EA, SJO, NE-O and AKE oversaw the final draft which was approved by all authors.

    • Funding NHS England funded the administrative support for BAPM to undertake the framework.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.