Robinson David L, Craig Mark S, Wells Ronald S, Liesemer Kirk N, Studer Matthew A
Primary Children's Hospital, Heart Center, 100 Mario Cappechi Dr., Salt Lake City, UT 84113.
Department of Pediatrics, Madigan Army Medical Center, 9040A Jackson Ave, JB Lewis-McChord, WA 98431.
Mil Med. 2019 Dec 1;184(11-12):826-831. doi: 10.1093/milmed/usz116.
The purpose of this study was to assess the evolution of newborn pulse oximetry screening (+POx) among Army, Air Force, and Naval military hospitals (MH), including prevalence, protocol use, quality assurance processes, access to echocardiography, and use of telemedicine. This is a follow-up from a prior study published in 2011.
An Internet-based questionnaire was forwarded to the chief pediatrician at MH worldwide which support newborn deliveries. Descriptive data were reported using percentages. Grouped responses, as applicable, were further compared using the chi-square test. A p-value < 0.05 was considered statistically significant.
Seventy-eight percent (36/46) of MH supporting deliveries worldwide responded to the survey (17 Army hospitals, 11 Navy Hospitals, 8 Air Force hospitals). All responding hospitals utilize +POx, of which 94% endorsed protocol compliance with the American Academy of Pediatrics guidelines. Nine (25%) hospitals were located outside of the United States. Delivery volumes (infants per month) range between 1-49 (36%), 50-99 (28%), 100-199 (19%), and 200-300 (17%). Eleven hospitals reported regular review of +POx data, with most reviewing them monthly. Four MH share findings with state institutions. Ten hospitals either have a staff pediatric cardiologist or use tele-echocardiography for on-site evaluations. Ten hospitals are located greater than 60 miles from the nearest center with echocardiography capabilities. Of the five hospitals using tele-echocardiography, four confirmed critical congenital heart disease (CCHD) using this practice, and all five reported averting transfer of an infant using this technology. Of the 22 hospitals lacking the ability to obtain on-site echocardiography, 12 (55%) are interested in implementing a tele-echocardiography protocol.
All responding MH use +POx, representing significant increase from the 30% of MH reporting use of +POx seven years ago. The majority of MH follow AAP +POx guidelines, and though most have providers review results prior to discharge, only one-third report periodic chart review for quality assurance. Most MH transfer infants with positive +POx results for evaluation due to a lack of on-site echocardiography. Tele-echocardiography was reported as a potential solution to diagnose or rule out CCHD. Over half of remaining hospitals without cardiologists are interested in using this technology to evaluate stable infants with positive CCHD screening.
本研究的目的是评估陆军、空军和海军军事医院（MH）中新生儿脉搏血氧饱和度筛查（+POx）的发展情况，包括患病率、方案使用情况、质量保证流程、超声心动图检查的可及性以及远程医疗的使用情况。这是对2011年发表的一项先前研究的随访。
向全球支持新生儿分娩的军事医院的首席儿科医生发送了一份基于互联网的调查问卷。描述性数据以百分比形式报告。适用时，使用卡方检验对分组后的回答进行进一步比较。p值<0.05被认为具有统计学意义。
全球支持分娩的军事医院中有78%（36/46）回复了调查（17家陆军医院、11家海军医院、8家空军医院）。所有回复的医院都采用+POx，其中94%认可符合美国儿科学会指南的方案。9家（25%）医院位于美国境外。分娩量（每月婴儿数）在1 - 49之间的占36%，50 - 99之间的占28%，100 - 199之间的占19%，200 - 300之间的占17%。11家医院报告定期审查+POx数据，大多数每月审查一次。4家军事医院与州立机构分享结果。10家医院有儿科心脏病专家或使用远程超声心动图进行现场评估。10家医院距离最近的具备超声心动图检查能力的中心超过60英里。在使用远程超声心动图的5家医院中，4家通过这种方式确诊了严重先天性心脏病（CCHD），并且所有5家都报告使用该技术避免了婴儿的转运。在22家缺乏现场超声心动图检查能力的医院中，12家（55%）有兴趣实施远程超声心动图检查方案。
所有回复的军事医院都使用+POx，与七年前报告使用+POx的军事医院比例为30%相比有显著增加。大多数军事医院遵循美国儿科学会的+POx指南，尽管大多数医院在出院前让医护人员查看结果，但只有三分之一的医院报告定期进行病历审查以保证质量。由于缺乏现场超声心动图检查，大多数军事医院会将+POx结果呈阳性的婴儿转诊进行评估。远程超声心动图被报告为诊断或排除CCHD的一种潜在解决方案。超过一半没有心脏病专家的剩余医院有兴趣使用这项技术来评估CCHD筛查呈阳性的稳定婴儿。
