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Information for Hospitals

The goal of the Wisconsin SHINE Project is to make sure all newborns are screened for Critical Congenital Heart Disease (CCHD) using pulse oximetry. The good news is that most hospitals in Wisconsin are already screening for CCHD.

Pulse Oximetry Screening for Congenital Heart Disease: Toolkit

Hospitals participating in the Wisconsin SHINE Project will be provided with the following assistance:

  • Basic Pulse Oximetry Screening Information
  • Standardized protocols for CCHD Screening in the Well Baby Nursery and NICU
  • 24 Hour technical assistance for questions about screening policy or procedure
  • Staff and parent education materials

In return, results of pulse oximetry screening at participating hospitals will be collected in a database and used to evaluate universal screening for CCHD in newborns.

Summary of Screening Recommendations

Screening

  • All babies in the well-baby nursery should be screened with pulse oximetry for CCHD. Most babies in the NICU will also be screened.
  • The results of the pulse oximetry screening should be reported on the blood card.
  • Pulse oximetry screening should be performed on babies with known CCHD even if they are on supplemental oxygen or PGE1.
  • Babies who are on supplemental oxygen for pulmonary disease at the time their blood card is collected should not have pulse oximetry screening performed and “Not Tested” should be reported on the blood card.
  • If additional blood cards are collected during the newborn hospitalization, pulse oximetry should be performed at that time if it was previously deferred.
  • Pulse oximetry screening should not replace a complete history and physical exam.
  • Screening should take place between 24 and 48 hours of life for healthy term babies. If early discharge is planned, screening should occur as late as possible prior to discharge.
  • Screening should be done in the right hand and one foot, in parallel or in sequence.
  • An adequate waveform should be observed for one full minute before pulse oximetry measurement is recorded.
  • Qualified personnel who have been educated in the use of the algorithm and trained in pulse oximetry monitoring of newborns should perform screening.
  • Any abnormal screen requires complete clinical evaluation.
  • Follow up of a failed screen should be initiated by the hospital or birth center upon obtaining failed screening result.

Equipment

  • Screening should be done with motion tolerant pulse oximeters that report functional oxygen saturation
  • Pulse oximeters can be used with either disposable or reusable probes.
  • Manufacture-recommended pulse oximeter-probe combinations should be used.

Communication

  • Results of the newborn CCHD screening should be communicated to the newborn’s primary care provider.
  • An appropriate mechanism should be established to ensure that the results of the pulse oximetry screening are recorded on the blood card and available to the infant’s primary care provider.
  • Primary care providers will need to develop strategies for evaluating newborns who are not screened for CCHD.
  • Healthcare providers must understand the rational for and limitations of pulse oximetry screening to detect CCHD.

Educate

  • Provide education materials to inform parents of the pulse oximetry screening program, including information about limitations of the screening program, the right to decline screening, and sources of more information.

Administration

  • Each hospital or birthing center should develop a policy for pulse oximetry screening that includes screening procedures, documentation, and reporting of results.
  • Each hospital or birthing center should establish a plan for management and evaluation of babies with positive screening results.
  • Each hospital or birthing center should establish a procedure for parents who decline screening.
  • Each hospital or birthing center should provide training in newborn pulse oximetry to individuals who will be involved in the screening process.