NewbornScreeningforCriticalCongenitalHeartDiseaseEducationforNursesThepurposeoftheCongenitalHeartDisease(CHD)ScreeningProgramistoidentifynewbornswithCHDpriortoclinicaldeteriorationoftheaffectedinfant.Delayeddiagnosisofcriticalcongenitalheartdisease(CCHD)canresultindeathorinjurytoinfants.Whydoweneedtoscreen?Congenitalheartdefects(CHDs)accountfor24%ofinfantdeathsduetobirthdefects.IntheUnitedStates,about4,800(or11.6per10,000)babiesborneveryyearhaveoneofsevencriticalcongenitalheartdefects(CCHDs,whichalsoareknowncollectivelyinsomeinstancesascriticalcongenitalheartdisease).CCHDFactSheetBabieswithoneoftheseCCHDsareatsignificantriskofdisabilityordeathiftheirCCHDisnotdiagnosedsoonafterbirth.ThesesevenCCHDsamongsomebabiespotentiallycanbedetectedusingpulseoximetryscreening,whichisatesttodeterminetheamountofoxygeninthebloodandpulserate.SevenCommonCCHD’sSomebabiesbornwithaheartdefectcanappearhealthyatfirstandcanbesenthomewiththeirfamiliesbeforetheirheartdefectisdetected.Ithasbeenestimatedthatatleast280infantswithanunrecognizedCCHDaredischargedeachyearfromnewbornnurseriesintheUnitedStates.Thesebabiesareatriskforhavingseriouscomplicationswithinthefirstfewdaysorweeksoflifeandoftenrequireemergencycare.WhyisthisImportant?NewbornscreeningusingpulseoximetrycanidentifysomeinfantswithaCCHDbeforetheyshowsignsofaCCHD.Onceidentified,babieswithaCCHDcanbeseenbycardiologistsandcanreceivespecializedcareandtreatmentthatcouldpreventdeathordisabilityearlyinlife.Treatmentcanincludemedicationsandsurgery.WhyPulseOximetry?Pulseoximetryisasimplebedsidetesttodeterminetheamountofoxygeninababy’sbloodandthebaby’spulserate.LowlevelsofoxygeninthebloodcanbeasignofaCCHD.Screeningisdonewhenababyis24to48hoursofage,oraslateaspossibleifthebabyistobedischargedfromthehospitalbeforeheorsheis24hoursofage.Pulseoximetryscreeningdoesnotreplaceacompletehistoryandphysicalexamination.Whenarebabiesscreened?RightHandandRightFootWheredoperformthetestonthebaby?Anurseshouldperformthetestafter24hoursofageorascloseaspossibletodischargeALLNEWBORNSWILLBESCREENEDUsetheAlgorithmstodeterminewhattodo.Thereisapassingalgorithmandafailingalgorithm.Whoperformsthetest?1.PlaceO2SatProbeonthenewbornsrighthandorrightfootfirst.O2satprobesareachargeitemandinPyxis.Thereare2sizestochoosefromNeo-LandInf-L,bothmadebyMasimo.2.Recordthereadingandthenswitchtowhateverextremityyoudidn’tstartwith.ONLYscreenRighthandandRightfoot.StepOne…IftheNewborn’ssaturationisgreaterthanorequalto95%inEITHERextremitywithalessthanorequalto3%differencebetweenthetwo,thewillbeconsideredaPASS.NoadditionalevaluationwillberequiredunlesssignsandsymptomsofCHDarepresent.Results…

PulseOx

95%(RHORRF)andDifferenceof

3%BetweenRHandRF

PASS

NormalNewbornCare

PassingAlgorithmPassingAlgorithm:PulseOx<95%(inBOTHRHANDRF)orDifferenceif>3%betweenRHANDRF.PASS FAILRepeatPulseOxin1hourPASS FAILRepeatPulseOxin1hourPASS FAILClinicalAssessmentandCallPhysicianFailingAlgorithmIfyouhaveafailingresultafterthethirdscreening:NotifythePhysicianInfectiousandpulmonarypathologyshouldbeexcludedCompleteechocardiogramasdirectedbytheinfantsphysician.Ifinfantissymptomatic,CALLphysicianimmediately!!Whatnext???YES,wecan.JamieinRadiologyisgettingtrainedCURRENTLY!Shehasbeenworkingonthisforafewmonths.Shehastogether‘practice’inbeforesheisonherown.Youwillsoonseeinformationaboutgettingher‘practice’newborns!!Canwedoechocardiogramshere?RecordtheResultsonthe‘CongenitalHeartDiseaseScreeningProgramForm.(clickhere)Alsocheckoffthe‘DischargeChecklist-Baby’inMeditechwhenitiscomplete.WheretoRecordResults…Pleaseclickhere:Whattowetellpatients?PleaseclickheretoaccessthepolicyIsthereaPolicy?Ame