O2046: National Impact of Universal Newborn Pulse Oximetry Screening: A multicenter, registry-based observational cohort study.

Background: Universal pulse oximetry screening (POS) for critical congenital heart disease (CCHD) was mandated by all states by 2018 with limited observational data describing post-mandate outcomes at state- or hospital-levels. We sought to characterize the impact of POS on age at initial admission to a children’s hospital and subsequent rates of in-hospital mortality.

Methods: A multicenter retrospective cohort study using the Pediatric Health Information Systems (PHIS) database was performed evaluating neonates with CCHD before and after universal POS mandate. We defined CCHD as 14 diagnoses identified by the American Academy of Pediatrics. A subgroup analysis was performed for 7 diagnoses considered highly sensitive to POS. Study periods for participating centers included the 7 years before and the 8 years following their respective state legislative mandate for POS, treating the year prior and 2 years after implementation as a washout period. Interrupted time series (ITS) analyses were performed to identify level and trend changes in average age at initial admission to a children’s hospital and in-hospital mortality rate following POS mandate.

Results: A total of 43,805 encounters from 43 participating PHIS children’s hospitals met study criteria. Following POS mandates, average age at admission underwent a level decrease after the washout period from 3.2 days to 2.4 days (p <.001). Before POS mandates, average age at admission did not change over time, but afterwards, average age at admission decreased 0.05 days/year (p=0.04); resulting in an overall slope decrease of 0.1 days/year (p=0.01). Following POS mandates, in-hospital mortality rate had a level increase after the washout period from 9.1 deaths per 100 patients to 11.6 deaths per 100 patients (p=0.03), yet the trend for in-hospital mortality rate over time did not change. Analyses for the subgroup limited to high sensitivity diagnoses were comparable to the main analyses.

Conclusion: For children with CCHD admitted to PHIS children’s hospitals, the average age at initial admission had a level decrease after the washout period, with a slope decrease after POS implementation. In-hospital mortality rate had a level increase after the washout period but no change in trend after implementation. We speculate that POS increased likelihood of CCHD diagnosis before discharge from the nursery resulting in the earlier age at admission to the children’s hospital. Additional research is needed to validate our findings and address knowledge gaps such as characterization of the impact of universal POS on outcomes including inpatient trajectory, acquired morbidities, and disparate healthcare resource utilization in rural and underserved communities.