GUIDELINES FOR CRITICAL CONGENITAL HEART DISEASE(CCHD) SCREENING

PURPOSE:

1. To aid in the early detection of critical congenital heart disease (CCHD) in Newborns before
discharge from the Hospital.

2. To develop strategies for the implementation of safe, effective, and efficient screening.

DEFINITION(S):

Newborn screening for critical CHDs involves a simple bedside test called pulse oximetry. This
test estimates the amount of oxygen in a baby’s blood. Low levels of oxygen in the blood can be
a sign of a critical CHD. The test is done using a machine called a pulse oximeter, with sensors
placed on the baby's skin. The test is painless and takes only a few minutes.

The seven primary targets of CCHD screening are:

1. Hypoplastic Left Heart Syndrome

2. Pulmonary Atresia (with intact atrial septum)
3. Tetrology of Fallot
4. Total Anomalous Pulmonary Venous Return
5. Transposition of the Great Arteries
6. Tricuspid Atresia
7. Truncus Arteriosus

Secondary screening targets include:

1. Aortic Arch Atresia or Hypoplasia
2. Interrupted Aortic Arch
3. Coarctation of the Aorta
4. Double-outlet right ventricle
5. Ebstein’s anomaly
6. Pulmonary stenosis/atresia
7. Atrioventricular septal defect
8. Ventricular septal defect
9. Other single ventricle defect (other than hypoplastic left heart syndrome and tricuspid
atresia)
The secondary defects can be just as serious as primary screening targets but may not be detected
as consistently with pulse oximeter screening.

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Passed Screens- An oxygen saturation measure that is ≥95% in the right hand or foot with a
≤3% absolute difference between the right hand or foot is considered a passed screen and
screening would end.
Failed Screen- An oxygen saturation measure is <90% (in the initial screen or in repeat screens),
Oxygen saturation is <95% in the right hand and foot on three measures, each separated by
one hour, or >3% absolute difference exists in oxygen saturation between the right hand and
foot on three measures, each separated by one hour.

Any infant who fails the screen should have a diagnostic echocardiogram. The Newborns’
pediatrician should be notified immediately and the infant might need to be seen by a
cardiologist.

POLICY STATEMENT:

1. CCHD Screening should be done as follows:

➢ When a baby is 12 – 24 hours of age, or as late as possible
➢ If the baby is to be discharged from the hospital before he or she is 12 hours of age.
➢ All newborns before transfer or discharge from the hospital (including NICU).
➢ All the out born newborn admissions to hospital.

2. In NICU, CCHD Screening should be done for the neonates (term and preterm) only on
room air or (After weaning from oxygen).

3. Do not apply pulse oximeter probe to the same extremity with a blood pressure cuff.

4. CCHD screening need not be done if ECHO was already done(Exclusion Criteria).

5. Ensure that the infant is not placed in bright or infrared light, including bilirubin lamps
and surgical lights, ( this can affect the accuracy of the reading.) while pulse oximeter is
being performed.

6. Cover the pulse oximeter probe with a blanket to ensure that extraneous light does not
affect the accuracy of your reading.

7. Use securement wrap to apply the pulse oximeter probe to the infant’s skin. ( do not
use tape)

8. Ensure that the infant is calm and warm during the reading(Movement, shivering and
crying can affect the accuracy of the pulse oximeter reading). Swaddle the infant and
encourage family involvement to promote comfort while obtaining the reading. If
possible conduct screening while the infant is awake.

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9. Any infant who fails the screen should have a diagnostic echocardiogram. The Newborns’
pediatrician should be notified immediately and the infant might need to be seen by a
cardiologist.

10. The nurse performing the screening should have completed training and passed the
competency on performing CCHD screening.

EQUIPMENT/MATERIAL/FORM(S)

1. Pulse Oximeter

➢ At least one motion-tolerant pulse oximeter to be used for screening

➢ One motion-tolerant pulse oximeter for back-up
2. Using either an Adhesive Disposable Sensor (Masimo M-LNCS® Neo) or Reusable Sensor
3. One disposable wrap per infant screened to secure sensor to hand or foot
4. Nurses progress notes
5. Log book/electronic medical record /CCHD card
6. Blankets for warming the infant and blocking extraneous light

PROCEDURE :

1. Identify infant that fits the criteria for CCHD screening:

➢ 12 - 24 hours of age (can be done before 12 hours of age if the infant is being
discharged).
➢ Vital signs within normal limits.
➢ On room-air.

2. Preparation for screening:

➢ Ensure to provide parent(s) with education related to the pulse oximeter screening and
CCHD.
➢ A quiet environment is ideal. Testing may be done in the nursery or patient room.
Parent(s) may be present.
➢ It is preferred that the infant is awake, alert but quiet during the test.
➢ Do not test on an actively crying infant or on a cold stressed infant.
➢ Bright lights and bilirubin lights should be turned off prior to screening.

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3. Procedure for Pulse oximetry Screening:

Select the CCHD mode on the Masimo Radical-7 machine

STEP 1: Sensor Placement on Right Hand

STEP 2: Sensor Placement on Either Foot

STEP 3: Screening Results

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4. Initial screening Results:

4.1 If the protocol criteria is met & complete, it is considered as PASS (Passed screen)
Screening is completed as PASS
➢ no further action is required
➢ Notify parent(s) of results and document the result in CCHD record, vaccination
card, patient medical record and the computer system.

4.2 If the protocol criteria is not met, it is considered as fail (failed screen) Screening is
completed as FAIL
➢ Repeat the screening one hour after the first screening (second time).
➢ Monitor infant for signs and symptoms of cardiac or respiratory distress.

5. Second screening Results:

5.1 If the protocol criteria is met & complete, it is considered as PASS (Passed screen)
Screening is completed as PASS
➢ No further action is required
➢ Notify parent(s) of results and document the result in CCHD record, vaccination
card, patient medical record and the computer system.

5.2 If the protocol criteria is not met, it is considered as fail (failed screen)
Screening is completed as FAIL
➢ Repeat the screening one hour after the second screening (third time).
➢ Monitor infant for signs and symptoms of cardiac or respiratory distress.

6. Third screening Results:

6.1 If the protocol criteria is met & complete, it is considered as PASS (Passed screen)
Screening is completed as PASS
➢ No further action is required
➢ Notify parent(s) of results and document the result in vaccination record, patient
medical record and the computer system.

6.2 If the protocol criteria is not met, it is considered as fail (failed screen)
Screening is completed as FAIL
➢ The infant’s pediatrician should be notified immediately and the infant need to
be seen by a cardiologist for diagnostic echocardiogram before discharge.
➢ Notify parent(s) of results and plan of care.
➢ Monitor infant for signs and symptoms of cardiac or respiratory distress.

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REFERENCES:

1. https://www.aap.org/en.../Newborn-Screening-for-CCHD.aspx
https://www.idph.state.ia.us/.../guidelines_newborn_screening.pdf
2. newborn CCHD Screening: Step-by-Step instructional ... - Masimo
www.masimo.com/.../LAB6252B_Sales_Tool_CCHD_Screening_Adhesive_ Sensor.pdf
3. Identifying newborns with critical congenital heart disease - UpToDate
www.uptodate.com/.../identifying-newborns-with-critical-congenital-heart- disease
4. Hospital Guidelines for Implementing Pulse Oximetry ...
www.adph.org/newbornscreening/.../FHS.NBS.CCHDGuidelines.0312.na
5. Facts About Critical Congenital Heart Defects | NCBDDD | CDC
www.cdc.gov/ncbddd/heartdefects/cchd-facts.html

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