Feasibility study assessing equitable delivery of newborn pulse oximetry screening in New Zealand's midwifery-led maternity setting

Elza Cloete; Thomas L Gentles; Lesley A Dixon; Dianne R Webster; Joshua D Agnew; Sarka Davidkova; Jane M Alsweiler; Jenny Rogers; Frank H Bloomfield; Pulse Oximetry Screening Steering Committee

doi:10.1136/bmjopen-2019-030506

Feasibility study assessing equitable delivery of newborn pulse oximetry screening in New Zealand's midwifery-led maternity setting

BMJ Open. 2019 Aug 18;9(8):e030506. doi: 10.1136/bmjopen-2019-030506.

Authors

Elza Cloete¹, Thomas L Gentles², Lesley A Dixon³, Dianne R Webster⁴, Joshua D Agnew⁵, Sarka Davidkova⁶, Jane M Alsweiler⁷, Jenny Rogers⁸, Frank H Bloomfield⁸; Pulse Oximetry Screening Steering Committee

Collaborators

Pulse Oximetry Screening Steering Committee:
Helen Wihongi, Julena Ardern, Nikki Edwards, Donna Foote, Rob Lutter, Chris McKinlay, Kelly Richards

Affiliations

¹ Liggins Institute, University of Auckland, Auckland, New Zealand e.cloete@auckland.ac.nz.
² Paediatric and Congenital Cardiac Service, Starship Children's Health, Auckland, New Zealand.
³ New Zealand College of Midwives Inc, Christchurch, New Zealand.
⁴ Newborn Metabolic Screening Unit, Auckland District Health Board, Auckland, New Zealand.
⁵ Department of Paediatrics, Tauranga Hospital, Tauranga, New Zealand.
⁶ Department of Paediatrics, Rotorua Hospital, Rotorua, New Zealand.
⁷ Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.
⁸ Liggins Institute, University of Auckland, Auckland, New Zealand.

Abstract

Objectives: The aim of this study was to conduct New Zealand-specific research to inform the design of a pulse oximetry screening strategy that ensures equity of access for the New Zealand maternity population. Equity is an important consideration as the test has the potential to benefit some populations and socioeconomic groups more than others.

Setting: New Zealand has an ethnically diverse population and a midwifery-led maternity service. One quaternary hospital and urban primary birthing unit (Region A), two regional hospitals (Region B) and three regional primary birthing units (Region C) from three Health Boards in New Zealand's North Island participated in a feasibility study of pulse oximetry screening. Home births in these regions were also included.

Participants: There were 27 172 infants that satisfied the inclusion criteria; 16 644 (61%) were screened. The following data were collected for all well newborn infants with a gestation age ≥35 weeks: date of birth, ethnicity, type of maternity care provider, deprivation index and screening status (yes/no). The study was conducted over a 2-year period from May 2016 to April 2018.

Results: Screening rates improved over time. Infants born in Region B (adjusted OR=0.75; 95% CI 0.67 to 0.83) and C (adjusted OR=0.29; 95% CI 0.27 to 0.32) were less likely to receive screening compared with those born in Region A. There were significant associations between screening rates and deprivation, ethnicity and maternity care provider. Lack of human and material resources prohibited universal access to screening.

Conclusion: A pulse oximetry screening programme that is sector-led is likely to perpetuate inequity. Screening programmes need to be designed so that resources are distributed in the way most likely to optimise health outcomes for infants born with cardiac anomalies.

Ethics approval: This study was approved by the Health and Disability Ethics Committees of New Zealand (15/NTA/168).

Keywords: congenital heart disease; health policy; neonatology; preventive medicine; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Feasibility Studies
Health Equity*
Humans
Infant, Newborn
Maternal-Child Health Centers
Midwifery
Neonatal Screening / methods*
New Zealand
Oximetry*