WOMEN & INFANT SERVICES
/ POLICY/PROCEDURE TITLE:Postductal oxygen saturation (POS) screening of healthy newborns /
RELATED TO:
Medical Center Policy (MCP) Nursing Practice Stds.
JCAHO Patient Care Stds.
QA Other
Title 22 / ADMINISTRATIVE CLINICAL PAGE 1 OF _
Effective date: 9/10 Revision date:
Review date:
Unit/Department of Origin: FMCC
Other Approval: ISCC
Key Elements:
1. Critical congenital heart defects (CCHD) occur in 2 per 1000 live births.
2. Antenatal ultrasound screening picks up many but not all heart defects in the fetus and the newborn physical exam may miss up to 50% of CCHD.
3. Up to 30 infants die of a missed or possibly late diagnosis of CCHD in California each year.
4. CCHD lesions are often dependent on the ductal blood flow, and when the duct closes, the infant has poor perfusion of vital organs and is at high risk of quickly becoming very ill.
5. POS screening may detect unknown CCHD’s. Although, a negative test result does not exclude the possibility of heart disease.
6. Early detection and treatment would allow these babies to be stabilized prior to corrective surgery.
POLICY STATEMENT:
1. All unmonitored newborns will have a postductal oxygen saturation (POS) screen prior to discharge.
(Definition of postductal: relating to that part of the aorta distal to the aortic opening of the ductus arteriosus; postductal saturations are obtained on the left hand or either foot.)
2. Normal newborn postductal oxygen saturation should be > 95% soon after birth.
3. A postductal oxygen saturation 95% can indicate abnormal mixing of oxygenated and deoxygenated blood
4. Infants who are found to have oxygen saturation < 95% require further evaluation.
5. Infants located in the Infant Special Care Center will have a postductal oxygen saturation (POS) screen prior to transfer or discharge.
RESPONSIBLE PARTY:
RN, NP, MD
EQUIPMENT: Oximeter, Oximeter probe, Stethoscope
PROCEDURE:
FMCC/Birth Center:
1. The POS screen will be done by the pediatric medical provider during the first newborn exam; preferably between 4 and 24 hours of life. Infants that were monitored in the ISCC and have a documented post ductal saturation 95% will not need additional screening.
2. Clean the oxygen sensor with alcohol prior to use.
3. For infants < 3kg, the oxygen sensor will be used with the Nellcor A/N Sensor Wrap around the infant’s foot. Assure that the foot is clean and dry prior to sensor placement.
4. For infants > 3 kg on FMCC and the Birth Center, the Nellcor Pedicheck D-YSPD clip will be used on the infant’s big toe. Assure that the foot is clean and dry prior to sensor placement. Please see diagram below for correct fit. The sensor should fit around the infant’s toe as illustrated in picture (c) or (d).
5. As the accuracy of saturation readings is affected by motion, the infant should remain as quiet as possible. It may be necessary to have the parent hold the infant throughout the procedure.
6. The accuracy of saturation readings may also be affected by ambient light, covering the infant’s extremity with a blanket may help minimize light interference. If the infant is on phototherapy, please turn off the lights during the procedure to decrease ambient light.
7. Observe the infant’s saturation for one minute, saturations should be 95%.
8. Infants who have an oxygen saturation of 95% for more than 10 seconds will be placed on the monitor in the Newborn Procedure Room with a disposable oxygen sensor.
9. If the infant continues to have an oxygen saturation 95% he/she will need to be transferred to ISCC for further management.
10. Pass results will be documented on the Newborn Record by the pediatric provider.
ISCC:
1. RNs responsible for the care of the infant located in the Infant Special Care Center will
obtain a postductal oxygen saturation prior to transfer or discharge.
2. Results will be documented in PCIS. Results of the the POS screen will be found in the vital sign section under “Saturation Screening”.
3. Abnormal screens (saturation 95%) will be reported to the ISCC pediatric provider for further work up and management.
REFERENCES:
Koppel RI, Druschel CM, Carter T, et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics 2003; 111:451-455
Mahle, W.T. et al. Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP. Peridatrics 2009; 124; 823-836. July 6, 2009.
Nellcor Oximax Dura-Y, Multiple Oxygen Sensor instruction manual, Tyco Healthcare Group, LP
Valmari P. Should pulse oximetry be used to screen for congenital heart disease? Arch Dis Child Fetal Neonatal ed.2007; 92: 219-224
Sendelbach DM, Jackson GL, Lai SS. Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects. Pediatrics 2008; 112:e815-820; originally published online Sep 1, 2008
Schultz AH, Localio AR, Clark BJ et al. Epidemiologic features of the presentation of critical congenital heart disease: implications for screening. Pediatrics 2008; 121: 751-757
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01/18/11 postductal oxygen saturation screening of healthy newborns.doc