Newborn Screening for Critical Congenital Heart Disease Education for Nurses

Why do we need to screen? The purpose of the Congenital Heart Disease (CHD) Screening Program is to identify newborns with CHD prior to clinical deterioration of the affected infant. Delayed diagnosis of critical congenital heart disease (CCHD) can result in death or injury to infants.

Who endorses this? The Department of Health and Human Services here in the United States made this CHD (also called CCHD—Critical Congenital Heart Disease) screening recommendation September of 2011. In January of this year, the American Academy of Pediatrics endorsed this recommendation. Our OB –PEDS team has recently approved the policy and we are ready to get started now! We had some questions to answer about newborn echocardiograms before we could get started!

CCHD Fact Sheet Congenital heart defects (CHDs) account for 24% of infant deaths due to birth defects. In the United States, about 4,800 (or 11.6 per 10,000) babies born every year have one of seven critical congenital heart defects (CCHDs, which also are known collectively in some instances as critical congenital heart disease).

What are CCHD’s? Seven of the most common CRITICAL CONGENITAL HEART DEFECTS are: Hypoplastic Left Heart Pulmonary Atresia Tetralogy of Fallot Transposition of the Great Arteries Tricuspid Atresia Truncus Arteriosus Total Anomalous Pulmonary venous Return

Seven Common CCHD’s Babies with one of these CCHDs are at significant risk of disability or death if their CCHD is not diagnosed soon after birth. These seven CCHDs among some babies potentially can be detected using pulse oximetry screening, which is a test to determine the amount of oxygen in the blood and pulse rate.

Why is this Important? Some babies born with a heart defect can appear healthy at first and can be sent home with their families before their heart defect is detected. It has been estimated that at least 280 infants with an unrecognized CCHD are discharged each year from newborn nurseries in the United States. These babies are at risk for having serious complications within the first few days or weeks of life and often require emergency care.

Why Pulse Oximetry? Newborn screening using pulse oximetry can identify some infants with a CCHD before they show signs of a CCHD. Once identified, babies with a CCHD can be seen by cardiologists and can receive specialized care and treatment that could prevent death or disability early in life. Treatment can include medications and surgery.

When are babies screened? Pulse oximetry is a simple bedside test to determine the amount of oxygen in a baby’s blood and the baby’s pulse rate. Low levels of oxygen in the blood can be a sign of a CCHD. Screening is done when a baby is 24 to 48 hours of age, or as late as possible if the baby is to be discharged from the hospital before he or she is 24 hours of age. Pulse oximetry screening does not replace a complete history and physical examination.

How can I have the most success? Make the newborn is warm and quiet Know how to correctly use the equipment and where to get supplies. Make sure you are getting accurate readings by assuring a good wave form and heart rate on the monitor. ALWAYS use the right hand and right foot Practice!

Where do perform the test on the baby? Right Hand and Right Foot

Who performs the test? A nurse should perform the test after 24 hours of age or as close as possible to discharge ALL NEWBORNS WILL BE SCREENED Use the Algorithms to determine what to do. There is a passing algorithm and a failing algorithm.

Step One… 1. Place O2 Sat Probe on the newborns right hand or right foot first. O2 sat probes are a charge item and in Pyxis. There are 2 sizes to choose from Neo-L and Inf-L, both made by Masimo. 2. Record the reading and then switch to whatever extremity you didn’t start with. ONLY screen Right hand and Right foot.

Results… If the Newborn’s saturation is greater than or equal to 95% in EITHER extremity with a less than or equal to 3% difference between the two, the will be considered a PASS. No additional evaluation will be required unless signs and symptoms of CHD are present.

Passing Algorithm Passing Algorithm:   Pulse Ox  95% (RH OR RF) and Difference of  3% Between RH and RF PASS Normal Newborn Care

“Failing” Results… If the oxygen Saturations are less than 95% in both the hand and foot or there is greater than 3% difference between the two on three measures each separated by one hour, the newborn should be referred for additional evaluation.  If the newborn’s saturation is less than 90% in either the hand or foot, he or she should be immediately referred for additional evaluation.

Failing Algorithm Pulse Ox <95% (in BOTH RH AND RF) or Difference if >3% between RH AND RF. PASS FAIL Repeat Pulse Ox in 1 hour Clinical Assessment and Call Physician

What next??? If you have a failing result after the third screening: Notify the Physician Infectious and pulmonary pathology should be excluded Complete echocardiogram as directed by the infants physician. If infant is symptomatic, CALL physician immediately!!

Can we do echocardiograms here? YES, we can. Jamie in Radiology is getting trained CURRENTLY! She has been working on this for a few months. She has to get her ‘practice’ in before she is on her own. You will soon see information about getting her ‘practice’ newborns!!

Where to Record Results… Record the Results on the ‘Congenital Heart Disease Screening Program Form. (click here) Also check off the ‘Discharge Checklist-Baby’ in Meditech when it is complete.

What to we tell patients? Please click here:

Is there a Policy? Please click here to access the policy

Don’t hesitate to ask questions! Thank-you! Don’t hesitate to ask questions!

References American Academy of Pediatrics Policy Statement. Pediatrics. Volume 129, Number 1, January 2012. Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease.