171: Implementation of A Simplified Pulse Oximetry Screening Program
Bibliographic record
Abstract
Newborn pulse oximetry screening increases detection of critical congenital heart disease otherwise missed by antenatal ultrasound and physical examination. The AAP endorsed a protocol checking oxygen saturations in the right hand and one foot at ≥24 h of age, with abnormal results (<95%) subject to repeat screening. We describe our experience in implementing a simplified protocol at a Canadian tertiary children's hospital and a referring regional hospital. We collected information from the screening program organizers. Cardiology chose a simplified screening protocol, checking oxygen saturations in one foot between 24 h and 36 h of age. This was supported by a meta-analysis indicating no significant differences in sensitivity or false positive rates compared to checking both foot and right hand (Thangaratinam, Lancet 2012). A single abnormal saturation (<95%) requires physician assessment. If the low saturation is confirmed and no other cause identified, an echocardiogram would be arranged within 24 h (utilizing telemedicine at the regional hospital). Physicians and nurses welcomed more ways to improve detection of CHD. Screening was started in February 2013 in the post partum unit at the tertiary hospital (approximately 4500 neonatal admissions annually) and in July 2013 at the regional hospital (approximately 900 annually). As of December 2013, there have been no positive screens. All cardiac surgery in the region comes to the tertiary hospital; we are aware of no false negative results. Education was delivered at a staff meeting followed by individual teaching as required, and a written protocol was distributed. As nurses were familiar with pulse oximetry, education focused on teaching the protocol. Reusable oximetry probes and probe wraps were used. Three dedicated oximeter machines were adequate for the tertiary unit and one was used at the regional site. Testing was usually done at bath time. We estimate it takes 10 minutes to do the screen, clean the probe and document. A selective chart review showed excellent compliance, but inconsistency in where results were being documented. Newborns discharged from the birthing unit and home births were not being screened. Our experience shows that a pulse oximetry screening program can be readily implemented. There are areas for improvement in documentation, and we identified groups to target for screening. We believe the simplified protocol and shifting the management of abnormal screens to the physician allowed for easier implementation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".