Pulse Oximetry Screening: Implementation Recommendations

Expanding the newborn screening process should prevent the delayed diagnosis of critical congenital heart disease (CCHD), which can result in death or injury to infants. The inclusion of pulse oximetry screening was the result of a lengthy review process in which William Mahle, M.D., pediatric cardiologist at the Children’s Healthcare of Atlanta Sibley Heart Center, played a crucial role.

Dr. Mahle led the development of the 2009 AAP/AHA statement and chaired the Secretary of Health and Human Services workgroup to develop the Strategies for Implementing Screening for Critical Congenital Heart Disease.

As a result, Sept. 21, 2011, Secretary of Health and Human Services Kathleen Sebelius recommended that pulse oximetry be added to the recommended uniform screening panel (RUSP). This improves on the current approach to detect CCHD, which has relied primarily on prenatal ultrasound and physical exams in the newborn nursery.

A number of studies show that adding pulse oximetry to the assessment of the newborn can enhance detection of CCHD. The readily available, noninvasive and painless technology can be easily incorporated into routine screenings.

This screening is targeted toward healthy newborns in the newborn nursery.

  • Screening should be performed with motion-tolerant pulse oximeters.
  • It is appropriate to use either disposable or reusable pulse oximetry probes.
  • Specific probes should meet the recommendations of the manufacturer.
  • Screening should not be undertaken until 24 hours of life, or as late as possible if early discharge is planned, in order to reduce the number of false positives. Separate consideration for home births is necessary.
  • Oxygen saturations should be obtained in the right hand and one foot.
  • Threshold for a positive screen is detailed in the publication and relates to both the absolute reading by the pulse oximeter, as well as the difference between the two extremities.
  • Pulse oximetry reading of ≥ 95 percent in either extremity, with a ≤ 3 percent absolute difference in the upper and lower extremity, would be considered a pass, and the screening would end.
  • To reduce false positives, it is recommended that repeated measurements be taken for cases in which the initial screen was positive.
  • Infants with saturations < 90 percent should receive immediate evaluation.
  • In the event of a positive screen, CCHD needs to be excluded based on a diagnostic echocardiogram. Infectious and pulmonary causes of hypoxemia should also be excluded.

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