NewbornScreeningforCriticalCongenitalHeartDiseaseEducationforNursesNewbornScreeningforCritical1ThepurposeoftheCongenitalHeartDisease(CHD)ScreeningProgramistoidentifynewbornswithCHDpriortoclinicaldeteriorationoftheaffectedinfant.Delayeddiagnosisofcriticalcongenitalheartdisease(CCHD)canresultindeathorinjurytoinfants.Whydoweneedtoscreen?ThepurposeoftheCongenital2TheDepartmentofHealthandHumanServiceshereintheUnitedStatesmadethisCHD(alsocalledCCHD—CriticalCongenitalHeartDisease)screeningrecommendationSeptemberof2011.InJanuaryofthisyear,theAmericanAcademyofPediatricsendorsedthisrecommendation.OurOB–PEDSteamhasrecentlyapprovedthepolicyandwearereadytogetstartednow!Wehadsomequestionstoansweraboutnewbornechocardiogramsbeforewecouldgetstarted!Whoendorsesthis?TheDepartmentofHealthandH3Congenitalheartdefects(CHDs)accountfor24%ofinfantdeathsduetobirthdefects.IntheUnitedStates,about4,800(or11.6per10,000)babiesborneveryyearhaveoneofsevencriticalcongenitalheartdefects(CCHDs,whichalsoareknowncollectivelyinsomeinstancesascriticalcongenitalheartdisease).CCHDFactSheetCCHDFactSheet4SevenofthemostcommonCRITICALCONGENITALHEARTDEFECTSare:HypoplasticLeftHeartPulmonaryAtresiaTetralogyofFallotTranspositionoftheGreatArteriesTricuspidAtresiaTruncusArteriosusTotalAnomalousPulmonaryvenousReturnWhatareCCHD’s?SevenofthemostcommonCRITI5BabieswithoneoftheseCCHDsareatsignificantriskofdisabilityordeathiftheirCCHDisnotdiagnosedsoonafterbirth.ThesesevenCCHDsamongsomebabiespotentiallycanbedetectedusingpulseoximetryscreening,whichisatesttodeterminetheamountofoxygeninthebloodandpulserate.SevenCommonCCHD’sBabieswithoneoftheseCCHDs6Somebabiesbornwithaheartdefectcanappearhealthyatfirstandcanbesenthomewiththeirfamiliesbeforetheirheartdefectisdetected.Ithasbeenestimatedthatatleast280infantswithanunrecognizedCCHDaredischargedeachyearfromnewbornnurseriesintheUnitedStates.Thesebabiesareatriskforhavingseriouscomplicationswithinthefirstfewdaysorweeksoflifeandoftenrequireemergencycare.WhyisthisImportant?WhyisthisImportant?7NewbornscreeningusingpulseoximetrycanidentifysomeinfantswithaCCHDbeforetheyshowsignsofaCCHD.Onceidentified,babieswithaCCHDcanbeseenbycardiologistsandcanreceivespecializedcareandtreatmentthatcouldpreventdeathordisabilityearlyinlife.Treatmentcanincludemedicationsandsurgery.WhyPulseOximetry?WhyPulseOximetry?8Pulseoximetryisasimplebedsidetesttodeterminetheamountofoxygeninababy’sbloodandthebaby’spulserate.LowlevelsofoxygeninthebloodcanbeasignofaCCHD.

Screeningisdonewhenababyis24to48hoursofage,oraslateaspossibleifthebabyistobedischargedfromthehospitalbeforeheorsheis24hoursofage.Pulseoximetryscreeningdoesnotreplaceacompletehistoryandphysicalexamination.

Whenarebabiesscreened?Pulseoximetryisasimplebed9MakethenewborniswarmandquietKnowhowtocorrectlyusetheequipmentandwheretogetsupplies.Makesureyouaregettingaccuratereadingsbyassuringagoodwaveformandheartrateonthemonitor.ALWAYSusetherighthandandrightfootPractice!HowcanIhavethemostsuccess?Makethenewborniswarmandq10RightHandandRightFootWheredoperformthetestonthebaby?RightHandandRightFootWhere11Anurseshouldperformthetestafter24hoursofageorascloseaspossibletodischargeALLNEWBORNSWILLBESCREENEDUsetheAlgorithmstodeterminewhattodo.Thereisapassingalgorithmandafailingalgorithm.Whoperformsthetest?Anurseshouldperformthetes121.PlaceO2SatProbeonthenewbornsrighthandorrightfootfirst.O2satprobesareachargeitemandinPyxis.Thereare2sizestochoosefromNeo-LandInf-L,bothmadebyMasimo.2.Recordthereadingandthenswitchtowhateverextremityyoudidn’tstartwith.ONLYscreenRighthandandRightfoot.StepOne…1.PlaceO2SatProbeonthe13IftheNewborn’ssaturationisgreaterthanorequalto95%inEITHERextremitywithalessthanorequalto3%differencebetweenthetwo,thewillbeconsideredaPASS.NoadditionalevaluationwillberequiredunlesssignsandsymptomsofCHDarepresent.Results…IftheNewborn’ssaturationis14

PulseOx95%(RHORRF)andDifferenceof3%BetweenRHandRF

PASS

NormalNewbornCare

PassingAlgorithmPassingAlgorithm:

PASSNormalNewbornCarePassin15IftheoxygenSaturationsarelessthan95%inboththehandandfootorthereisgreaterthan3%differencebetweenthetwoonthreemeasureseachseparatedbyonehour,thenewbornshouldbereferredforadditionalevaluation.

Ifthenewborn’ssaturationislessthan90%ineitherthehandorfoot,heorsheshouldbeimmediatelyreferredforadditionalevaluation.“Failing”Results…IftheoxygenSaturationsare16PulseOx<95%(inBOTHRHANDRF)orDifferenceif>3%betweenRHANDRF.PASS FAILRepeatPulseOxin1hourPASS FAILRepeatPulseOxin1hourPASS FAILClinicalAssessmentandCallPhysicianFailingAlgorithmPulseOx<95%(inBOTHRHAND17Ifyouhaveafailingresultafterthethirdscreening:NotifythePhysicianInfectiousandpulmonarypathologyshouldbeexcludedCompleteechocardiogramasdirectedbytheinfantsphysician.Ifinfantissymptomatic,CALLphysicianimmediately!!Whatnext???Ifyouhaveafailingresulta18YES,wecan.JamieinRadiologyisgettingtrainedCURRENTLY!Shehasbeenworkingonthisforafewmonths.Shehastogether‘practice’inbeforesheisonherown.Youwillsoonseeinformationaboutgettingher‘practice’newborns!!Canwedoechocardiogramshere?YES,wecan.JamieinRadiolo19RecordtheResultsonthe‘CongenitalHeartDiseaseScreeningProgramForm.(clickhere)Alsocheckoffthe‘DischargeChecklist-Baby’inMeditechwhenitiscomplete.WheretoRecordResults…RecordtheResultsonthe‘Con20Pleaseclickhere:Whattowetellpatients?Pleaseclickhere:Whattowet21PleaseclickheretoaccessthepolicyIsthereaPolicy?Pleaseclickheretoaccessth22Don’thesitatetoaskquestions!Thank-you!Don’thesitatetoaskquestion23AmericanAcademyofPediatricsPolicyStatement.Pediatrics.Volume129,Number1,January2012.EndorsementofHealthandHumanServicesRecommendationforPulseOximetryScreeningforCriticalCongenitalHeartDisease.ReferencesAmericanAcademyofPediatrics24NewbornScreeningforCriticalCongenitalHeartDiseaseEducationforNursesNewbornScreeningforCritical25ThepurposeoftheCongenitalHeartDisease(CHD)ScreeningProgramistoidentifynewbornswithCHDpriortoclinicaldeteriorationoftheaffectedinfant.Delayeddiagnosisofcriticalcongenitalheartdisease(CCHD)canresultindeathorinjurytoinfants.Whydoweneedtoscreen?ThepurposeoftheCongenital26TheDepartmentofHealthandHumanServiceshereintheUnitedStatesmadethisCHD(alsocalledCCHD—CriticalCongenitalHeartDisease)screeningrecommendationSeptemberof2011.InJanuaryofthisyear,theAmericanAcademyofPediatricsendorsedthisrecommendation.OurOB–PEDSteamhasrecentlyapprovedthepolicyandwearereadytogetstartednow!Wehadsomequestionstoansweraboutnewbornechocardiogramsbeforewecouldgetstarted!Whoendorsesthis?TheDepartmentofHealthandH27Congenitalheartdefects(CHDs)accountfor24%ofinfantdeathsduetobirthdefects.IntheUnitedStates,about4,800(or11.6per10,000)babiesborneveryyearhaveoneofsevencriticalcongenitalheartdefects(CCHDs,whichalsoareknowncollectivelyinsomeinstancesascriticalcongenitalheartdisease).CCHDFactSheetCCHDFactSheet28SevenofthemostcommonCRITICALCONGENITALHEARTDEFECTSare:HypoplasticLeftHeartPulmonaryAtresiaTetralogyofFallotTranspositionoftheGreatArteriesTricuspidAtresiaTruncusArteriosusTotalAnomalousPulmonaryvenousReturnWhatareCCHD’s?SevenofthemostcommonCRITI29BabieswithoneoftheseCCHDsareatsignificantriskofdisabilityordeathiftheirCCHDisnotdiagnosedsoonafterbirth.ThesesevenCCHDsamongsomebabiespotentiallycanbedetectedusingpulseoximetryscreening,whichisatesttodeterminetheamountofoxygeninthebloodandpulserate.SevenCommonCCHD’sBabieswithoneoftheseCCHDs30Somebabiesbornwithaheartdefectcanappearhealthyatfirstandcanbesenthomewiththeirfamiliesbeforetheirheartdefectisdetected.Ithasbeenestimatedthatatleast280infantswithanunrecognizedCCHDaredischargedeachyearfromnewbornnurseriesintheUnitedStates.Thesebabiesareatriskforhavingseriouscomplicationswithinthefirstfewdaysorweeksoflifeandoftenrequireemergencycare.WhyisthisImportant?WhyisthisImportant?31NewbornscreeningusingpulseoximetrycanidentifysomeinfantswithaCCHDbeforetheyshowsignsofaCCHD.Onceidentified,babieswithaCCHDcanbeseenbycardiologistsandcanreceivespecializedcareandtreatmentthatcouldpreventdeathordisabilityearlyinlife.Treatmentcanincludemedicationsandsurgery.WhyPulseOximetry?WhyPulseOximetry?32Pulseoximetryisasimplebedsidetesttodeterminetheamountofoxygeninababy’sbloodandthebaby’spulserate.LowlevelsofoxygeninthebloodcanbeasignofaCCHD.

Screeningisdonewhenababyis24to48hoursofage,oraslateaspossibleifthebabyistobedischargedfromthehospitalbeforeheorsheis24hoursofage.Pulseoximetryscreeningdoesnotreplaceacompletehistoryandphysicalexamination.

Whenarebabiesscreened?Pulseoximetryisasimplebed33MakethenewborniswarmandquietKnowhowtocorrectlyusetheequipmentandwheretogetsupplies.Makesureyouaregettingaccuratereadingsbyassuringagoodwaveformandheartrateonthemonitor.ALWAYSusetherighthandandrightfootPractice!HowcanIhavethemostsuccess?Makethenewborniswarmandq34RightHandandRightFootWheredoperformthetestonthebaby?RightHandandRightFootWhere35Anurseshouldperformthetestafter24hoursofageorascloseaspossibletodischargeALLNEWBORNSWILLBESCREENEDUsetheAlgorithmstodeterminewhattodo.Thereisapassingalgorithmandafailingalgorithm.Whoperformsthetest?Anurseshouldperformthetes361.PlaceO2SatProbeonthenewbornsrighthandorrightfootfirst.O2satprobesareachargeitemandinPyxis.Thereare2sizestochoosefromNeo-LandInf-L,bothmadebyMasimo.2.Recordthereadingandthenswitchtowhateverextremityyoudidn’tstartwith.ONLYscreenRighthandandRightfoot.StepOne…1.PlaceO2SatProbeonthe37IftheNewborn’ssaturationisgreaterthanorequalto95%inEITHERextremitywithalessthanorequalto3%differencebetweenthetwo,thewillbeconsideredaPASS.NoadditionalevaluationwillberequiredunlesssignsandsymptomsofCHDarepresent.Results…IftheNewborn’ssaturationis38

PulseOx95%(RHORRF)andDifferenceof3%BetweenRHandRF

PASS

NormalNewbornCare

PassingAlgorithmPassingAlgorithm:

PASSNormalNewbornCarePassin39IftheoxygenSaturationsarelessthan95%inboththehandandfootorthereisgreaterthan3%differencebetweenthetwoonthreemeasureseachseparatedbyonehour,thenewbornshouldbereferredforadditionalevaluation.

Ifthenewborn’ssaturationislessthan90%ineitherthehandorfoot,heorsheshouldbeimmediatelyreferredforadditionalevaluation.“Failing”Results…IftheoxygenSaturationsare40PulseOx<95%(inBOTHRHANDRF)orDifferenceif>3%betweenRHANDRF.PASS FAILRepeatPulseOxin1hourPASS FAILRepeatPulseOxin1hourPASS FAILClinicalAssessmentandCallPhysicianFailingAlgorithmPulseOx<