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Newborn Screening for Critical Congenital Heart Defects (CCHD)

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Subsections on this page:

Resources


Screening for Critical Congenital Heart Defects from the CDC - This is a relatively non-invasive procedure that can be done at home by a qualified midwife.

Information for Healthcare Providers, including Critical CHD Screening Methods

State Legislation, Regulations, and Hospital Guidelines for Newborn Screening for Critical Congenital Heart Defects — United States, 2011–2014

Critical congenital heart defects (CCHD) occur in approximately two of every 1,000 live births. . . . In the absence of early detection, infants with CCHD are at risk for serious complications or death within the first few days or weeks of life.

I was surprised the number was that high; it's close to the risk from GBS, which gets a lot more attention.  And it's many times more of a risk than vitamin K issues (i.e. Hemorrhagic Disease of the Newborn), which also gets a lot of attention.  However, unlike GBS and vitamin K issues, performing the preventive measure is totally uncontroversial--just checking the baby's oxygen saturation in the right hand and right foot.

Newborn CCHD Screening: Step-by-Step instructional guide from Masimo, which makes sensors for newborn pulse-oximetry that are supposed to work well even if the baby is moving around.

California's GUIDELINES FOR CRITICAL CONGENITAL HEART DISEASE SCREENING SERVICES - page 6 has the Interpretation of Screening Results.

Does hyperbilirubinemia affect pulse oximetry readings?  This article says not, although it hints that some say that the pulse oximetry readings could be artificially high.

Personally, I've noticed that the babies who are moderately jaundiced seem to have lower pulse oximetry numbers than I would expect, especially when resting.  When reasonably active, their numbers are in the 90s, but their at-rest numbers are more in the 80s.  This makes some sense to me since bilirubin is an antioxidant.  This is from a small sample size, but it would be great to see some more authoritative sources on the subject.

I have a high-end pulse oximeter for neonatal assessments, but it was designed under the assumption that you would be doing long-term monitoring.  So the neonatal sensor came with adhesive strips for attaching the sensor to the baby's foot.  We're not supposed to use adhesive on newborn skin unless absolutely necessary, so I was trying to hold it in place with the adhesive strip with the backing still on it.  This worked sometimes but not always and not very well.

I have started using cohesive tape and been very, very happy with how well this works and that I don't have to use a nasty adhesive strip on baby's delicate skin.  It seems to work well even if the baby is a little active, as in a quiet alert state.  If you do the assessment while the baby is sleeping, their oxygen saturation might be lower.  If you do it when they're too active, a standard pulse oximeter won't work.

Pulse Oximetry Newborn Screening for Critical Congenital Heart Defects from the Indiana State - In June 2011, the Indiana legislature added pulse oximetry to Indiana's newborn screen.


This is a very good overview.  They offer a tutorial to guide your facility through the process of determining whether a device or sensor has been FDA-cleared for use in neonates.


Guidelines for Newborn Screening for Critical Congenital Heart Disease from the Iowa Neonatal Screening Programs, Aug., 2012 - another good overview.

Their chart uses the baby's right hand and foot.


Pulse Oximeter Devices


Pulse Ox for Providers - Children's National Medical Center on YouTube

Type of Pulse Ox Matters for Newborn Heart Defect Screening - a helpful blog

It’s interesting to note that the large studies to date looking at the effectiveness of pulse oximetry screening for CCHD have all used one brand, Masimo. Masimo has unique technology that allows it to keep reading through motion.

These devices are fairly pricey, ranging from $950 to $4995, plus another $290 for a reusable neonatal sensor.  This seems outside the budget of most homebirth midwives, but I would hope that birth centers would be able to have them in house.

I have a high-end pulse oximeter for neonatal assessments, but it was designed under the assumption that you would be doing long-term monitoring.  So the neonatal sensor came with adhesive strips for attaching the sensor to the baby's foot.  We're not supposed to use adhesive on newborn skin unless absolutely necessary, so I was trying to hold it in place with the adhesive strip with the backing still on it.  This worked sometimes but not always and not very well.

I have started using cohesive tape and been very, very happy with how well this works and that I don't have to use a nasty adhesive strip on baby's delicate skin.  It seems to work well even if the baby is a little active, as in a quiet alert state.  If you do the assessment while the baby is sleeping, their oxygen saturation might be lower.  If you do it when they're too active, a standard pulse oximeter won't work. 

 

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