99nicu Poll: Do you screen well babies before discharge using pulse oximetry?

[Stefan Johansson]

There is a growing body of data suggesting that pulse oximetry before discharge from maternity wards can identify complex but yet asymptomatic cardiac malformations.

It would be interesting to hear how common such screening has become.

Please comment below too!

The poll is open until 31 Jan 2012.

[JACK]

May I also invite our members who have pulse oximetry screening at their hospital to kindly share their experiences (successes/failures) with us.

[Guest Sueh]

Hi, we screen those babies who have colour changes or if parents are concerned at present. We have a new delivery suite and have put a pulse oximeter in place to make it easier to do routine screening of all newborns prior to discharge.

[anja stein]

We implemented Pulseox-Screening 1 year ago, because we missed one child with critical pulmonary valve stenosis. It was the weekend, vaginal delivery was uneventful, systolic murmur was detected on the first day of life, the child well without dyspnea, due to the weekend echo was not available without contacting the cardiologist on-call, second well-child check was planned on monday, cyanosis was not detected my the nurses, although they did not see the child very often due to rooming-in. The doctor who did the examination on monday confirmed the systolic murmor and did Sat-Screening because she found the child cyanotic (preductal SO2 80%). From this case we learned that skin color is not very reliable and a child with CHD may be missed especially in a setting with family-rooms and rooming in.

So far we did not identify a child with CHD by screening.

[Guest drtaher]

I work in a Ministry of Health Hospital in Saudi Arabia. I recently came across this tool for screening for cyanotic congenital heart disease. I have ensured compliance with this at our hospital. So far, we have not picked up any positive case.

[Guest jridky]

In the United States, the Health and Human Services Secretary has recommended that pulse ox screening prior to discharge become a part of the routine newborn screening. This has been endorsed by the AAP as well. I have yet to see it implemented in the hospitals where I work (travel nurse) however anticipate that it will soon be a standard of care. CCHD can be easily missed as was evidenced to me when I cared for a term nursery infant who was a vaginal birth, face presentation, quite bruised African American. The nursery staff assured me that he "has always looked that way" when I questioned his color (this was my first shift working with this staff as I am a travel NICU nurse who had just started at that hospital and was assigned NBN for a cross orientation). Fortunately for this infant his mother did not want him to spend the night in her room so he was in the bright lights in the nursery. With my second round of cares I again questioned his appearance and was assured he was fine and besides his MD had already written his discharge for the morning. THird round of cares I was more than alarmed and learned that in fact the nursery had access to a pulse ox. WHen I checked him, the baby had equal pre and post ductal sats, both in the low to mid 80s. I put him on a warmer and administered oxygen, noting that it took a considerable time to get his sats above 90 and for his color to change. The infant had no murmur. The NNP was called from the NICU and initially saw no problem with the infant other than the bruising. I removed the oxygen and the sats immediately fell to the low 70s. Long story short, double outlet right ventricle, huge VSD, coarctation of the aorta and a closing PDA. He was put on prostin and flown to a tertiary care center for surgery. Had the infant spent the night in the room with his mother and had I not been a NICU nurse with strong convictions the infant most likely would not have survived. I am a strong advocate of mandatory pulse ox screening and this case is just one illustration of why. Had this infant been screened prior to my intervention he would have already been in the NICU, worked up and on his way to the appropriate hospital. Everyone should insist on mandatory pulse ox screening for ALL infants prior to discharge.

[Karen]

We do not routinely check a well-infant's pulse ox prior to discharge, however, if there is any questions of congenital cardiac defects, either by history or examination, we would then check pre and post ductal saturations.

[ATEFSHAFEI]

so interesting to screen all well babies with pulse oximetry ....

i am working in quite busy unit and unfortunately ,sometimes, babies are discharged earlier than 24 hours..a questionable realability of such screening!!!!!!

second, we have noted many well babies with structurally normal hearts( by echo.) and still have sat. difference between upper and lower limbs more than the -the recommended 3 % difference-

again neonates with complex ht. disease and no significant sat. difference.....although we are using sensetive masimo devices....

i am afraid our colleagues in cardiac service will suffer alot !!!!!!!!!!!!!!!!!!!!!!!!

[Guest rlazarte]

Inova Fairfax Hospital for Children at Falls Church, Virginia we started screening all newborns for congenital heart disease on July 2011. Data on results and outcomes is not available yet.

[siddalex]

We do a pre and post ducal o2 sat on all infants prior to discharge in well baby nursery as well as NICU

[szaman1971]

In Poland since last 2 years all newborns has a preductal pulsoximetry before discharge.

For scientific purposes inclusion criteria are gestational age >34hbd and no signs of circulatory or respiratory problems, exclusion criteria is serious congenital anomalies [this babies has pulsoximetry due to ilness]. The baby should be calm and nourished.

In my unity (2000 deliveries per year) we did not identify a child with CDH since introducing this test.

The test is performed after 2 hours of life before transition from delivery room to maternal unit. Testing takes 3 minutes. If preductal sat is >=95% the test is negative, if the preductal sat is < 95% (positive test) we repeat the test before discharge [24 -36 hours of life or later] - newborns usually are discharged after 48 hours of life). If sat is <95% we perform screening echocardiography.

In babies with heart murmur or marked cyanosis on physical examination despite negative puloximetry test (sat >=95) we usually make echo to exclude CHD.

I know that first test is performed very early ( maybe too early - DA still opened). But performing test before transition from delivery room provides in that we don't miss the baby to screen.

I am not a fan of this test but I see that my assistants, nurses, midwives and parents accepted this test. The most important is that it is not invasive, easy to perform and repeated. And my observation is that we perform less screening echocariography thanks to this test ( of course data not published).

[Stefan Johansson]

It would be interesting to hear about the need for echocardiography, and whether it has increased.

According to the studies, specificity for this screening has been very high, i.e. the rate of false positive being low. And consequently, the argument is that the screening can be introduced without increasing the workload much for echo technicians/cardiologists.

[varady]

Laco

The guideline of Slovak Neonatal Society has recommended that pulse oximetry screening prior to discharge become a part of the routine newborn screening.