新生儿先天性心脏病筛查

When are babies screened?
Pulse oximetry is a simple bedside test to determine the amount of oxygen in a baby’s blood and the baby’s pulse rate. Low levels of oxygen in the blood can be a sign of a CCHD.
Why is this Important?
Some babies born with a heart defect can appear healthy at first and can be sent home with their families before their heart defect is detected. It has been estimated that at least 280 infants with an unrecognized CCHD are discharged each year from newborn nurseries in the United States. These babies are at risk for having serious complications within the first few days or weeks of life and often require emergency care.
Pulse oximetry screening does not replace a complete history and physical examination.
How can I have the most success?
Make the newborn is warm and quiet Know how to correctly use the equipment and where
What are CCHD’s?
Seven of the most common CRITICAL CONGENITAL HEART DEFECTS are:
Hypoplastic Left Heart Pulmonary Atresia Tetralogy of Fallot Transposition of the Great Arteries Tricuspid Atresia Truncus Arteriosus Total Anomalous Pulmonary venous Return
ALL NEWBORNS WILL BE SCREENED Use the Algorithms to determine what to do. There is a
passing algorithm and a failing algorithm.
Step One…
1. Place O2 Sat Probe on the newborns right hand or right foot first. O2 sat probes are a charge item and in Pyxis. There are 2 sizes to choose from Neo-L and InfL, both made by mo.
Delayed diagnosis of critical congenital heart disease (CCHD) can result in death or injury to infants.
Who endorses this?
The Department of Health and Human Services here in the United States made this CHD (also called CCHD—Critical Congenital Heart Disease) screening recommendation September of 2011.
Newborn Screening for Critical Congenital Heart Disease
Education for Nurses
Why do we need to screen?
The purpose of the Congenital Heart Disease (CHD) Screening Program is to identify newborns with CHD prior to clinical deterioration of the affected infant.
PASS Normal Newborn Care
“Failing” Results…
If the oxygen Saturations are less than 95% in both the hand and foot or there is greater than 3% difference between the two on three measures each separated by one hour, the newborn should be referred for additional evaluation.
Where do perform the test on the baby?
Right Hand and Right Foot
Who performs the test?
A nurse should perform the test after 24 hours of age or as close as possible to discharge
2. Record the reading and then switch to whatever extremity you didn’t start with. ONLY screen Right hand and Right foot.
Results…
If the Newborn’s saturation is greater than or equal to 95% in EITHER extremity with a less than or equal to 3% difference between the two, the will be considered a PASS.
Why Pulse Oximetry?
Newborn screening using pulse oximetry can identify some infants with a CCHD before they show signs of a CCHD. Once identified, babies with a CCHD can be seen by cardiologists and can receive specialized care and treatment that could prevent death or disability early in life. Treatment can include medications and surgery.
What next???
If you have a failing result after the third screening: Notify the Physician Infectious and pulmonary pathology should be
Seven Common CCHD’s
Babies with one of these CCHDs are at significant risk of disability or death if their CCHD is not diagnosed soon after birth. These seven CCHDs among some babies potentially can be detected using pulse oximetry screening, which is a test to determine the amount of oxygen in the blood and pulse rate.
to get supplies. Make sure you are getting accurate readings by
assuring a good wave form and heart rate on the monitor. ALWAYS use the right hand and right foot Practice!
In January of this year, the American Academy of Pediatrics endorsed this recommendation.
Our OB –PEDS team has recently approved the policy and we are ready to get started now! We had some questions to answer about newborn echocardiograms before we could get started!
If the newborn’s saturation is less than 90% in either the hand or foot, he or she should be immediately referred for additional evaluation.
Failing Algorithm
Screening is done when a baby is 24 to 48 hours of age, or as late as possible if the baby is to be discharged from the hospital before he or she is 24 hours of age.
Pulse Ox <95% (in BOTH RH AND RF) or Difference if >3% between RH AND RF.
PASS
FAIL
Repeat Pulse Ox in 1 hour
PASS
FAIL
Repeat Pulse Ox in 1 hour
PASS
FAIL
Clinical Assessment and Call Physician
No additional evaluation will be required unless signs and symptoms of CHD are present.
Passing Algorithm
Passing Algorithm:
Pulse Ox 95% (RH OR RF) and Difference of 3% Between RH and RF
CCHD Fact Sheet
Congenital heart defects (CHDs) account for 24% of infant deaths due to birth defects. In the United States, about 4,800 (or 11.6 per 10,000) babies born every year have one of seven critical congenital heart defects (CCHDs, which also are known collectively in some instances as critical congenital heart disease).