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POX Screening Decision Tool

Information for Home Births

AAP Recommends Pulse Oximetry Screening Be Performed After Planned Home Births and Hospital BirthsMany babies in Wisconsin are born in settings outside of the hospital. This may include births that take place at home or in freestanding birthing centers. Universal screening for CCHD using pulse oximetry is recommended for all babies in Wisconsin, regardless of location of delivery.  This recommendation was recently reinforced by the American Academy of Pediatrics in the 2013 Policy Statement on Home Births.

The goal of the Wisconsin SHINE Project is to make sure all newborns are screened for Critical Congenital Heart Disease (CCHD) using pulse oximetry, including those born at free-standing birth centers or at home. We encourage all midwives to participating in this valuable, life-saving program.

The greatest challenges to screening babies born outside the hospital are access to screening equipment, timing the screen appropriately, and ensuring timely follow up when needed.  

If you need more information on pulse oximetry screening or midwife attended out-of-hospital birth, please contact the Wisconsin Guild of Midwives.

For more information on direct-entry midwifery in Wisconsin, visit the Wisconsin Guild of Midwives.

Summary of Screening Recommendations


  • 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.


  • 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.


  • 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.


  • 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.


  • 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

Forms & Handouts

Family Brochure
To order multiple copies of the Family Brochure, please complete this form.

Pulse Oximetry Screening for Congenital Heart Disease: Toolkit (coming soon!)

WISHINE Protocol


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.


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.

Wisconsin Department of Health Services Newborn Screening Program

Wisconsin State Laboratory of Hygiene Newborn Screening Laboratory

University of Wisconsin Pulse Oximetry Screening Program

Children’s Heart Foundation

Mended Little Hearts

One in One Hundred (March of Dimes)