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Key messages

  • Newborn oxygen saturation screening improves the detection of critical congenital heart disease (CHD) to 92 per cent of cases. Congenital heart defects that do not present with hypoxaemia may not be identified.
  • The oxygen screening test complements the newborn examination and is used to detect hypoxaemia in infants who otherwise appear well.
  • Screening may identify diverse causes and results may prompt further examination and investigation.
  • Screening may delay discharge in a small number of infants.

Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

Time of oximetry screening

Well infant on the postnatal ward

  • Ideally, screening is performed 24 hours after birth on infants who appear well and the screening is performed during standard working hours (08:00 to 16:00).
  • If necessary, screening can be performed as early as four hours and up to 48 hours after birth.
  • Early screening (prior to 24 hours) is more likely to reflect transitional circulation and may be falsely low (false positive).
  • If possible, the saturation screening can be done at the time of the discharge check.
  • For infants discharged before four hours who pass the saturation screening test and have a normal newborn examination, no further screening is necessary.

Infant in SCN

  • All infants admitted to the special care nursery (SCN), including long-stay infants with chronic lung disease who may be on supplemental low flow oxygen, should have a formal oxygen saturation screen with results documented before transfer to the postnatal ward or before discharge home.
  • Staff should clarify saturation values, assessments and follow up with the paediatric team and document in the progress notes.

Procedure for oximetry screening

Refer to the newborn oximetry screening flowchart for more information.

  • Obtain verbal parental consent and give parents written information.
  • Correctly identify infant.
  • Avoid screening while crying or feeding. The recording is best done on a settled infant.
  • Apply a clean and reusable pulse oximeter sensor to either foot.
Figure 1: Oximeter attached to foot
Figure 1: Oximeter attached to foot

Photograph courtesy of Ballarat Health Service

  • Switch on the oximeter and connect the applied probe to the oximeter. This allows for best signal acquisition.
  • The time taken for a good trace may vary between 30 seconds to 2 minutes.
  • Allow 30 seconds of good pulse signals prior to recording the saturation value.

Results of oximetry screening

Oxygen saturation is 95 per cent or higher:

  • No further screening is required.
  • If newborn examination is also normal no referral is needed.

Oxygen saturation is 90-94 per cent:

  • Refer the infant for clinical assessment by the paediatric team or discuss with PIPER.
  • Clinical assessment includes examination for:
    • murmurs
    • femoral pulses
    • evaluation of pre-ductal and post-ductal oxygen saturations.
  • If the infant has a normal clinical examination and no more than three per cent difference between pre-ductal (right hand) and post-ductal (foot) oxygen saturations, a repeat saturation screen is performed three hours later.
  • If there are any doubts about the infant's wellbeing, admit the infant to the SCN for further investigation.
  • Investigations include:
    • four limb blood pressure
    • echocardiogram (echo); a normal electrocardiogram (ECG) may not exclude a cardiac lesion
    • chest x-ray.
  • If the repeat screen has saturations of 90-94 per cent, request a review by the paediatric consultant and further investigations performed as above.
  • If there is no other identifiable cause for hypoxaemia after appropriate evaluation by the consultant paediatrician, refer the infant to Cardiology.
  • For a repeat saturation of 95 per cent or higher, together with normal femoral pulses at this time, no further assessments are necessary.
  • For an infant first screened at 48 hours and beyond a saturation of < 95 per cent, admit the infant to the SCN for further assessment as this is usually indicative of an underlying pathology.

Oxygen saturation is less than 90 per cent:

  • This requires an urgent referral to the paediatric team/ PIPER and admission to SCN with further investigations that may include Cardiology referral.
  • A neonatal MET call should be considered

Cardiology referral:

  • An abnormal clinical examination (such as being unable to obtain a good reading from one foot) requires early referral to the paediatric team for assessment and management.
  • CHD needs to be excluded if assessment by the paediatric consultant gives no other adequate explanation for hypoxaemia.
  • A paediatric cardiology referral will be necessary to discuss:
    • further timing of an echo
    • transport to a centre for an echo
    • assessment by cardiology.

Documentation of oximetry screening:

The screening results should be documented in the medical record and documentation should include:

  • date and time of screening
  • foot used
  • results - pass or refer.

Get in touch

Centre of Clinical Excellence - Women and Children
Safer Care Victoria

Version history

First published: June 2016

Last reviewed: October 2018

Review by: June 2019

UNCONTROLLED WHEN DOWNLOADED

Page last updated: 17 Feb 2021

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