Programs
Kansas Newborn CCHD Screening
Birthing Hospital, Facilities & Midwives
Pulse oximetry screening should be performed by qualified personnel trained in newborn pulse oximetry screening and Kansas’ recommended screening algorithm. Health care professionals are responsible for educating parents about pulse oximetry screening before screening takes place. Screening is best performed between 24 and 48 hours of life for healthy term newborns. If discharged before 24 hours of life, screening should occur as close as possible to the time of discharge. Earlier screening may produce false positive results due to the newborn’s transition from fetal to neonatal circulation and the stabilization of systemic oxygen saturation levels.
Birth facilities are responsible for selecting and securing pulse oximetry equipment for screening newborns for CCHD. A variety of pulse oximeters are available for use with newborns. Please contact our program staff with any questions regarding pulse oximeter options and their compatibility with KDHE reporting systems. It is important to ensure that the selected equipment is compliant with national standards for screening newborns, including all of the following:
- Approval by the Food and Drug Administration (FDA) for use in newborns
- Validation in low-perfusion conditions and provides accurate readings with movement
- 2% root, mean-square accuracy
- Reporting of functional oxygen saturation
Hospitals should choose a probe recommended by the pulse oximeter manufacturer for use with the device. Both disposable and reusable probes with disposable foam wrap are available and acceptable for screening. At the time of screening, hospital and birth facilities should:
Communicate newborn pulse oximetry screening information and parental options to parents before screening.
Screen all infants for CCHD after 24 hours but before discharge, unless parents have signed a parental refusal form.
Report all pulse oximetry results to the Kansas Department of Health Newborn Screening Program using the CCHD Reporting Form.
Health care professionals should inform parents about the benefits and risks of newborn screening and the specific benefits and risks associated with choosing to opt-out of any part of newborn screening.
All pulse oximetry screening results and follow-up arrangements should be reported to KDHE. Results should be communicated with parents both verbally and in writing once the final screen is complete. Education materials to aid in the discussion about pulse oximetry screening are available and can be ordered through the Kansas Newborn Screening Program.
Physicians
The Kansas NBS programs rely on healthcare professionals to educate parents about newborn screening and its benefits before screening takes place. Pulse oximetry screening should be performed by qualified personnel trained in newborn pulse oximetry screening and Kansas’ recommended screening algorithm. Screening is best performed between the first 24 and 48 hours of life for healthy term newborns.
Address any questions or concerns expectant parents may have and refer them to the Kansas Department of Health Newborn Screening Program website for further information. We recommend the following to meet the legal requirements:
- Provide and review the newborn screening results.
- Allow parents the opportunity to ask questions.
Babies with CCHD may appear healthy at birth but are at risk for serious, life-threatening complications. If CCHD is detected early, treatments are often available that can help affected newborns lead longer, healthier lives. If a parent is considering refusing newborn screening, it is important to review the following points:
- Newborns with the health problems we screen for often appear healthy at birth and have no family history of the disorder.
- Screening for CCHD is painless and takes only a few minutes. There are no side effects or health risks associated with this screening procedure.
- Newborns with these health problems can die, become developmentally delayed, or damage can be irreversible if not identified early by newborn screening.
- If a parent refuses screening, the parent must sign a refusal form, which will be documented in the baby’s medical record and sent to the Kansas Department of Health Newborn Screening Program: Refusal of Newborn Screening Form.
Screening Recommendations, Communications & Follow Up/Reporting
Our program recommends using a slightly modified protocol from the one endorsed by the US Secretary of Health and Human Services and the American Academy of Pediatrics. The recommended screening algorithm is:
- Perform pulse oximetry screening when the baby is quiet and alert.
- Measure oxygen saturations on the right hand and either the right or left foot (measurements can be done simultaneously or in direct sequence).
- Ensure good pulse waveform for at least one full minute.
States that have adopted this updated approach have shown an increase in the detection rate of CCHD. The current recommended protocol for screening in Kansas is reflected in all educational materials and the reporting system.
All pulse oximetry screening results and follow-up arrangements should be communicated to the newborn’s parents and reported to KDHE. Results should be shared with parents verbally and in writing once the final screen is complete.
Pass Result
If the infant receives a pass result, give the parent(s) the Pass Result: Pulse Oximetry Result Notification sheet and explain that pulse oximetry does not detect all cases of CCHD. Should concerns arise, encourage parent(s) to contact their infant’s primary care provider.
Did Not Pass Result
If the infant receives a non-passing result, give the parent(s) the Did Not Pass Result: Pulse Oximetry Result Notification sheet and discuss what further evaluation and/or testing is needed and the timeframe for that testing.
We recommend that health care professionals take the following steps for any newborn with a non-passing pulse oximetry result:
- Perform a comprehensive evaluation for causes of hypoxemia
- If a non-cardiac explanation for the hypoxemia is not identified, CCHD must be excluded on the basis of a diagnostic echocardiogram:
- A diagnostic echocardiogram should not be replaced by other cardiac evaluations (e.g., chest radiograph, electrocardiogram)
- It is recommended that the diagnostic echocardiogram occurs within four hours of the final pulse oximetry screen.
- A CME-credit approved Sonographer Education training is available to assist cardiac sonographers in performing the initial neonatal echocardiogram as part of a comprehensive evaluation for hypoxemia.
Pediatric cardiology specialists are available to consult on any non-passing pulse oximetry screen result and can help discuss stabilization and transport needs and/or provide interpretation of echocardiogram findings. Echo results should be sent to KDHE using the Echocardiogram Result Report form.