Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

Braun, Kim Van Naarden; Grazel, Regina; Koppel, Robert; Lakshminrusimha, Satyanarayana; Lohr, Jamie L.; Kumar, Prerna; Govindaswami, Balaji; Giuliano, Michael; Cohen, Morris J.; Spillane, Nicole T.; Jegatheesan, Priya; McClure, Diane; Hassinger, Denise C.; Fofah, Onajovwe; Chandra, Shakuntala; Allen, Delena; Axelrod, Randi; Blau, Jonathan; Hudome, Susan; Assing, E.; Garg, Lorraine F.

doi:10.1038/jp.2017.105

Cited by 14 publications

(23 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These issues could be addressed or minimized by implementing quality metrics and through the use of electronic decision support tools [33,36]. Best practices are still being developed with regards to screening special populations, particularly home births, births at altitude, and evaluating whether screening of infants in neonatal intensive care units is effective [37]. Colorado requires CCHD screening of infants born at moderate altitude, accepting a higher false positive rate when compared to infants born at sea level [38].…”

Section: Lessons Learnedmentioning

confidence: 99%

Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

Wandler

Martin

2017

IJNS

View full text Add to dashboard Cite

Abstract:A national approach to screening for critical congenital heart disease (CCHD) using pulse oximetry was undertaken in the United States. Following the scientific studies that laid the groundwork for the addition of CCHD screening to the U.S. Recommended Uniform Screening Panel (RUSP) and endorsement by professional societies, advocates including physicians, nurses, parents, medical associations, and newborn screening interest groups were able to successfully pass laws requiring the screen on a state by state basis. Public health involvement and screening requirements vary by state. However, a common algorithm, education, and implementation strategies were shared nationally as well as CCHD toolkits to aid in the implementation in hospitals. Health Resources & Services Administration (HRSA) grants to pilot states encouraged the development of a public health infrastructure around screening, data collection, and quality measures. The formation of a CCHD NewSTEPs technical advisory work group provided a systematic way to tackle challenges and share best practices by hosting monthly meetings and webinars. CCHD screening is now required in 48 states, with over 98% of U.S. births being screened for CCHD using pulse oximetry. A standard protocol has been implemented in most states. While the challenges related to screening special populations and quantifying screening outcomes through the creation of a national data repository remain; universal implementation is nearly complete.

show abstract

Section: Lessons Learnedmentioning

confidence: 99%

Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

Wandler

Martin

2017

IJNS

View full text Add to dashboard Cite

show abstract

“…No CCHD was detected in this study. 18 Overall, these studies suggest that in asymptomatic infants in the NICU being monitored by a pulse oximeter, the addition of a pulse oximeter-based screen, performed either 24 to 48 hours after admission or before discharge would not detect additional infants with CCHD.…”

Section: Current Evidence: a Literature Reviewmentioning

confidence: 87%

Critical Congenital Heart Disease Screening in NICU: Need for Revision and Standardization

et al. 2017

View full text Add to dashboard Cite

Screening for critical congenital heart disease (CCHD) at 24 to 48 hours after birth or before discharge in newborn nurseries using pulse oximetry is effective and is mandated by most states. However, there is no established protocol for screening in a neonatal intensive care unit (NICU), a setting where neonates are continuously monitored by pulse oximetry, hypoxemia from noncardiac causes is common, and echocardiograms are frequently obtained. CCHDs with hypoxemia are suspected on admission and investigated with an echocardiogram before a formal screen in the NICU. The most common CCHD lesions missed in a NICU setting are secondary targets of the screen, such as aortic arch anomalies (coarctation or interrupted aortic arch). The sensitivity of the current pulse oximeter–based CCHD screen to diagnose aortic arch anomalies is low. Given that infants are monitored with continuous pulse oximetry and frequent examinations, novel revisions to the current screening methods are necessary to detect asymptomatic NICU infants with aortic arch anomalies before discharge. Exclusions (whom to screen), technique (how to screen), and timing (when to screen) for primary and secondary targets of CCHD in the NICU are not known and require further research.

show abstract

“…17 An NICU-specific multicenter collaborative found that the number of infants not screened according to the protocol was approximately 1.1%. 18…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement Interventions to Improve Critical Congenital Heart Disease Screening

Hom

Salcedo

Revenis

et al. 2019

Pediatric Quality &Amp; Safety

View full text Add to dashboard Cite

Introduction:Newborn screening for critical congenital heart disease (CCHD) using pulse oximetry improves detection and is associated with decreased related infant mortality. In 2015, the Healthy Hearts of Babies Act required hospitals to screen all newborns in the District of Columbia for CCHD using pulse oximetry and to provide documentation of individual screening results to the Department of Health. A regulatory report from the electronic health record revealed an opportunity to improve both documentation and protocol adherence within our hospital. We aimed to reduce documentation errors and protocol violations by 75% and sustain this improvement for 6 months.Methods:In February of 2014, our center, a large free-standing children’s hospital, implemented CCHD screening in the neonatal intensive care unit on all infants without known congenital heart disease or receiving supplemental oxygen. During the intervention period (January 2016 to December 2018), an interdisciplinary team engaged in regular review and analysis of reports, monthly closed-loop feedback, and iterative refinements to the electronic health record. Statistical process control charts were used to compare a baseline period to the intervention period and track monthly progress.Results:Between February 2014 and December 2018, we screened 2,214 infants for CCHD. The average percentage of documentation errors decreased from 23.5% during the baseline period to 1.2% during the intervention period, a sustained reduction for over 2 years. Protocol violations occurred at an average of 2.1% in the baseline period, with a sustained decrease to 0.6% during the intervention period.Conclusions:This multimodal quality improvement project demonstrated a sustained reduction of CCHD screening documentation errors and protocol violations.

show abstract

Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

Cited by 14 publications

References 19 publications

Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

Critical Congenital Heart Disease Screening in NICU: Need for Revision and Standardization

Quality Improvement Interventions to Improve Critical Congenital Heart Disease Screening

Contact Info

Product

Resources

About