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Information for Hospitals

The goal of the Wisconsin SHINE Project is to assist hospitals and healthcare providers screen newborns for Critical Congenital Heart Disease (CCHD) using pulse oximetry. In 2014 pulse oximetry screening for CCHD was added to the newborn screening panel. All infants are required to have pulse oximetry screening before they are discharged from the hospital after they are born.

Pulse Oximetry Screening for Congenital Heart Disease: Toolkit

Through the Wisconsin Department of Health Services (DHS), the Wisconsin SHINE Project provides hospitals and healthcare providers with the following resources:

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

Summary of Screening Recommendations

Screening

  • All babies in the well-baby nursery should be screened with pulse oximetry for CCHD. Babies admitted to the NICU will also be screened.
  • The results of the pulse oximetry screening should be reported on the blood card.
  • Reporting of screening results should NEVER delay the submission of the blood card.
  • 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.
  • There are times when pulse oximetry screening for congenital heart disease is not necessary or not appropriate (CCHD confirmed or excluded by post-natal echocardiography, death, parental refusal, or transfer to another facility). If pulse oximetry was appropriately deferred at the time of newborn screening, please mark the reason on the blood card.

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 rationale 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 ad 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.

Additional Resources

References

The external resources provided below are listed for the convenience of providers and institutions. They are offered "as is" and Wisconsin SHINE cannot guarantee the correctness or authenticity of the information/links below.


Kemper A et al. Strategies for Implementing Screening for Critical Congenital Heart Disease. Pediatrics 2011.

Hoffman J, Kaplan S. The Incidence of Congenital Heart Disease. Journal of the American College of Cardiology 2002.