新生儿先天性心脏病筛查.pptx

新生儿先天性心脏病筛查.pptx

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NewbornScreeningforCriticalCongenitalHeartDiseaseEducationforNursesThepurposeoftheCongenitalHeartDisease（CHD）ScreeningProgramistoidentifynewbornswithCHDpriortoclinicaldeteriorationoftheaffectedinfant.Delayeddiagnosisofcriticalcongenitalheartdisease（CCHD）canresultindeathorinjurytoinfants.Whydoweneedtoscreen?

TheDepartmentofHealthandHumanServiceshereintheUnitedStatesmadethisCHD（alsocalledCCHDCriticalCongenitalHeartDisease）screeningrecommendationSeptemberof2011.InJanuaryofthisyear,theAmericanAcademyofPediatricsendorsedthisrecommendation.OurOBPEDSteamhasrecentlyapprovedthepolicyandwearereadytogetstartednow!

Wehadsomequestionstoansweraboutnewbornechocardiogramsbeforewecouldgetstarted!

Whoendorsesthis?

Congenitalheartdefects（CHDs）accountfor24%ofinfantdeathsduetobirthdefects.IntheUnitedStates,about4,800（or11.6per10,000）babiesborneveryyearhaveoneofsevencriticalcongenitalheartdefects（CCHDs,whichalsoareknowncollectivelyinsomeinstancesascriticalcongenitalheartdisease）.CCHDFactSheetSevenofthemostcommonCRITICALCONGENITALHEARTDEFECTSare:

HypoplasticLeftHeartPulmonaryAtresiaTetralogyofFallotTranspositionoftheGreatArteriesTricuspidAtresiaTruncusArteriosusTotalAnomalousPulmonaryvenousReturnWhatareCCHDs?

BabieswithoneoftheseCCHDsareatsignificantriskofdisabilityordeathiftheirCCHDisnotdiagnosedsoonafterbirth.ThesesevenCCHDsamongsomebabiespotentiallycanbedetectedusingpulseoximetryscreening,whichisatesttodeterminetheamountofoxygeninthebloodandpulserate.SevenCommonCCHDsSomebabiesbornwithaheartdefectcanappearhealthyatfirstandcanbesenthomewiththeirfamiliesbeforetheirheartdefectisdetected.Ithasbeenestimatedthatatleast280infantswithanunrecognizedCCHDaredischargedeachyearfromnewbornnurseriesintheUnitedStates.Thesebabiesareatriskforhavingseriouscomplicationswithinthefirstfewdaysorweeksoflifeandoftenrequireemergencycare.WhyisthisImportant?

NewbornscreeningusingpulseoximetrycanidentifysomeinfantswithaCCHDbeforetheyshowsignsofaCCHD.Onceidentified,babieswithaCCHDcanbeseenbycardiologistsandcanreceivespecializedcareandtreatmentthatcouldpreventdeathordisabilityearlyinlife.Treatmentcanincludemedicationsandsurgery.WhyPulseOximetry?

Pulseoximetryisasimplebedsidetesttodeterminetheamountofoxygeninababysbloodandthebabyspulserate.LowlevelsofoxygeninthebloodcanbeasignofaCCHD.Screeningisdonewhenababyis24to48hoursofage,oraslateaspossibleifthebabyistobedischargedfromthehospitalbeforeheorsheis24hoursofage.Pulseoximetryscreeningdoesnotreplaceacompletehistoryandphysicalexamination.Whenarebabiesscreened?

MakethenewborniswarmandquietKnowhowtocorrectlyusetheequipmentandwheretogetsupplies.Makesureyouaregettingaccuratereadingsbyassuringagoodwaveformandheartrateonthemonitor.ALWAYSusetherighthandandrightfootPractice!

HowcanIhavethemostsuccess?

RightHandandRightFootWheredoperformthetestonthebaby?

Anurseshouldperformthetestafter24hoursofageorascloseaspossibletodischargeALLNEWBORNSWILLBESCREENEDUsetheAlgorithmstodeterminewhattodo.Thereisapassingalgorithmandafailingalgorithm.Whoperformsthetest?

1.PlaceO2SatProbeonthenewbornsrighthandorrightfootfirst.O2satprobesareachargeitemandinPyxis.Thereare2sizestochoosefromNeo-LandInf-L,bothmadebyMasimo.2.Recordthereadingandthenswitchtowhateverextremityyoudidntstartwith.ONLYscreenRighthandandRightfoot.StepOneIftheNewbornssaturationisgreaterthanorequalto95%inEITHERextremitywithalessthanorequalto3%differencebetweenthetwo,thewillbeconsideredaPASS.NoadditionalevaluationwillberequiredunlesssignsandsymptomsofCHDarepresent.ResultsPulseOx95%（RHORRF）andDifferenceof3%BetweenRHandRFPASSNormalNewbornCarePassingAlgorithmPassingAlgorithm:

IftheoxygenSaturationsarelessthan95%inboththehandandfootorthereisgreaterthan3%differencebetweenthetwoonthreemeasureseachseparatedbyonehour,thenewbornshouldbereferredforadditionalevaluation.Ifthenewbornssaturationislessthan90%ineitherthehandorfoot,heorsheshouldbeimmediatelyreferredforadditionalevaluation.“Failing”ResultsPulseOx3%betweenRHANDRF.PASSFAILRepeatPulseOxin1hourPASSFAILRepeatPulseOxin1hourPASSFAILClinicalAssessmentandCallPhysicianFailingAlgorithmIfyouhaveafailingresultafterthethirdscreening:

qNotifythePhysicianqInfectiousandpulmonarypathologyshouldbeexcludedqCompleteechocardiogramasdirectedbytheinfantsphysician.qIfinfantissymptomatic,CALLphysicianimmediately!

Whatnext?

YES,wecan.JamieinRadiologyisgettingtrainedCURRENTLY!

Shehasbeenworkingonthisforafewmonths.Shehastogetherpracticeinbeforesheisonherown.Youwillsoonseeinformationaboutgettingherpracticenewborns!

Canwedoechocardiogramshere?

RecordtheResultsontheCongenitalHeartDiseaseScreeningProgramForm.（clickhere）AlsocheckofftheDischargeChecklist-BabyinMeditechwhenitiscomplete.WheretoRecordResultsPleaseclickhere:

Whattowetellpatients?

PleaseclickheretoaccessthepolicyIsthereaPolicy?

Donthesitatetoaskquestions!

Thank-you!

AmericanAcademyofPediatricsPolicyStatement.Pediatrics.Volume129,Number1,January2012.EndorsementofHealthandHumanServicesRecommendationforPulseOximetryScreeningforCriticalCongenitalHeartDisease.References