Active Pregnancy, Children & Inherited Conditions Public Health & Healthcare

Screening for clinical conditions associated with hypoxaemia in newborns using pulse oximetry: Protocol for an exploratory cost-effectiveness decision analytic model

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A pulse oximeter—the small clip placed on a newborn’s foot—could become a routine screening tool for a range of hidden conditions that starve babies of oxygen. Currently, pulse oximetry (PO) screening is not standard practice across the UK for all newborns. This matters because low blood oxygen (hypoxaemia) is a common sign of several serious but treatable conditions, including critical congenital heart disease, sepsis, and persistent pulmonary hypertension. Without screening, these conditions can be missed until a baby becomes critically ill. The research aims to give the UK National Screening Committee the robust economic evidence it needs to decide whether to introduce PO screening nationwide. If the modelling shows screening is cost-effective, the impact could be straightforward: more babies would be diagnosed earlier, treated sooner, and avoid severe complications or death. The change would be invisible to most families—just a few extra seconds with a sensor—but it would quietly improve the safety net for every newborn in the country. If the model finds screening is not cost-effective, the research will still clarify where future studies or data collection would be most valuable, preventing wasted effort on unproven programmes.

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The objective of this study is to generate robust evidence to inform UK NSC decision- making on the potential introduction of newborn PO screening. The initial screening focus for this study will be on hypoxaemia, recognising that it is a clinical manifestation common to a range of underlying conditions (e.g., CCHD, sepsis, PPHN), but this will be refined through scoping searches and stakeholder engagement. The study will: 1. Use scoping searches and stakeholder meetings to refine the list of hypoxaemia associated conditions on which sufficient evidence may be available for CEA modelling. 2. Conduct rapid reviews for evidence on prior CEA models, test accuracy, and health and cost outcomes to inform CEA modelling on the selected conditions. 3. Develop a CEA model incorporating clinician and patient and public perspectives to evaluate the potential economic and health impacts of introducing newborn PO screening for hypoxaemia in the UK setting. 4. Conduct threshold analysis to explore the conditions under which PO screening becomes cost-effective/ cost-ineffective. 5. Conduct value of information analysis to estimate the value of additional evidence generation in the form of trial or routine data.

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