ASHFORD & ST PETER’S HOSPITALS NHS FOUNDATION TRUST



ASHFORD & ST PETER’S HOSPITALS NHS FOUNDATION TRUST

Pulse Oximetry Screening for Critical Congenital Heart Disease in Asymptomatic Newborns

(As part of Newborn Examination)

Background

• Congenital heart disease (CHD) is the most common type of congenital abnormality, affecting about 7-8 in 1000 babies and accounting for 6-10% of all infant deaths.

• At the more critical end of the spectrum, the incidence of a duct dependent circulation is 1-1.8 babies per 1000 live births

• Antenatal ultrasonography and the newborn clinical examination can miss a significant percentage (up to 30%) of babies born with life threatening congenital cardiac malformations.

• Combining the use of pulse oximetry with clinical examination improves this detection rate to 92%.

Pulse oximetry testing before discharge is an effective, non-invasive, inexpensive screening tool to assist in diagnosing critical congenital heart disease.

• The normal Oxygen saturation in newborn babies is >95% after 10-15 minutes of life.

• Every baby must have its oxygen saturation measured as part of the routine newborn examination prior to hospital discharge.

• Note: A negative screen does not exclude the possibility of congenital heart disease

Pulse Oximetry Algorithm

In all newborn babies, measure O2 saturation pre-ductal (Right hand) and post ductal

(Right or Left Foot) as part of the newborn examination

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O2 saturation 90-95% or >3% difference in saturations between the two readings

O2 saturation >95% & d"3% difference in saturations

O2 Saturation less than 90%

Screening is negative.

Complete the process by documenting in baby records

Admit to neonatal unit

Work up for congenital heart dis

O2 saturation >95% & ≤3% difference in saturations

O2 Saturation less than 90%

Screening is negative.

Complete the process by documenting in baby records

Admit to neonatal unit

Work up for congenital heart disease, Pulmonary disease & Sepsis

Inform neonatal consultant

Discuss need for an echocardiogram

( Dr Otunla, Dr Groves or external cardiology referral)

Inform middle grade paediatrician for urgent review

Dr T Otunla-November 2012

Inform middle grade paediatrician

O2 saturation 90-95% or >3% difference in saturations between the two readings

Repeat pulse oximetry in an hour

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