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. Infants born in Wisconsin are required to have pulse oximetry screening before they are discharged from the hospital after they are born.
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 Newborn Nursery and NICU
- Technical assistance for questions about screening policy or procedure
- Education materials
Wisconsin Shine Screening Protocol
Summary of Screening Recommendations
Screening
- All newborns admitted to the Newborn Nursery and the NICU will be screened with pulse oximetry for CCHD. Exceptions are newborns requiring oxygen and newborns who have an echocardiogram before the recommended screening time.
- Results of the pulse oximetry screen should be reported on the blood card.
- Reporting CCHD screening results should NEVER delay the submission of the blood card.
- Newborns who are on supplemental oxygen for pulmonary disease at the time their blood card is collected should not have pulse oximetry screening and “Not Screened” should be reported on the blood card.
- Pulse oximetry screening should not replace a complete history and physical exam.
- Screening should take place between 24 and 48 hours of life. 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:
- Newborn on oxygen
- Echocardiogram done prior to recommended screening time
- Death
- Parental refusal
- 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.
Education
- 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.
