CHHS18/108

Canberra Hospital and Health ServicesClinical ProcedurePulse Oximetry Screening - NeonatesContents

Contents...................................................................................................................................1

Purpose.................................................................................................................................... 2

Scope........................................................................................................................................2

Section 1 – Pulse Oximetry Screening......................................................................................2

Section 2 – Pulse Oximetry Screening Flowchart.....................................................................4

Implementation........................................................................................................................5

Related Policies, Procedures, Guidelines and Legislation.........................................................5

References................................................................................................................................5

Definition of Terms...................................................................................................................6

Search Terms............................................................................................................................6

Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2021 WY&C – Dept of

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CHHS18/108

Purpose

The purpose of this document is to outline the use of arterial pulse oximetry screening in neonates born at or transferred to Canberra Hospital and Health Services (CHHS) within 24 hours of birth to detect mild hypoxia caused by congenital heart disease or lung disease.

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Scope

This procedure applies to all staff involved in the care of neonates, working within their scope of practice including:nurses/midwives medical staff New nursing/midwifery or medical staff, or students (if within their defined scope of practice) will be required to perform these skills under the direct supervision of a competent practitioner.

This document pertains to neonates born at or transferred to Canberra Hospital and Health Services (CHHS).

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Section 1 – Pulse Oximetry Screening

Equipment Alcohol based hand rub (ABHR) Saturation monitor Saturation probe Documentation

Procedure 1. Screening is to be performed on all neonates no earlier than 4 hours following birth2. Neonates admitted to the Neonatal Intensive Care Unit (NICU) or Special Care Nursery

(SCN) from Birthing have arterial oxygen saturation (SaO2) recorded on discharge, when well, while breathing ROOM AIR before stopping cardiorespiratory monitoring. (for neonates to be discharged on oxygen on a steady lowflow prior to stopping monitoring). Results are to be documented on the: Neonatal Early Warning Score (NEWS) chart Well Baby Assessment Chart Discharge Summary neonatal register by neonatal staff

3. Attach pulse oxygen saturation probe to either foot of neonate (post-ductal)4. Connect the probe to the oxygen saturation monitor

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CHHS18/108

5. Monitor for a minimum of 2 and a maximum of 5 minutes until a stable recording is achieved (same SpO2 displayed for minimum 30 seconds)

6. The neonate must be quiet during the reading7. Saturations must be above 95% 8. If saturations below 95% follow Section 2: Pulse Oximetry Screening Flowchart 9. Clinical symptoms of congenital heart or lung disease may also include:

persistent low SpO2 cyanosis tachypnoea (respiratoy rate [RR] >60/minute) lethargy poor feeding oedema

10. This screening does not replace a clinical examination. Routine clinical examination (by neonatal RMO or midwife) must be performed prior to discharge

11. Document the findings on the Baby Care Chart and Birthing Outcome System (BOS) or in the NICUS database if the baby is in NICU or SCN

12. Inform woman of test and results13. The doctor/midwife completing the neonatal baby check should review the screening

results

Low saturations may indicate delayed adaptation, lung disease, infection or be a sign of congenital heart disease. Further investigations/management will be decided in conjunction with the on call Neonatologist. After clinical examination, investigations should include temperature, pre/post ductal saturation, 4 limb blood pressure, Full Blood Count (FBC), CRP, Chest x-ray (CXR) +/- blood cultures. If no cause is identified and the saturation remains low inpatient cardiologist review with echocardiography is warranted. If there is no cardiologist available, inpatient assessment by a neonatologist trained in Clinicain Performed Ultrasound (CPU) with outpatient follow up is an acceptable alternative.

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Section 2 – Pulse Oximetry Screening Flowchart

Babies admitted to Department of Neonatology from Birthing have saturations recorded on discharge, when well, in AIR prior to stopping monitoring. (for infants to be discharged in oxygen on a steady lowflow prior to stopping monitoring). Results

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documented on the ‘Well Baby Assessment Chart’, ‘Discharge Summary’ and in the neonatal register by neonatal staff.

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Implementation

This is an updated procedure. Staff will be informed of the update via Sharepoint, in existing training programs and in-services. New staff will be made aware of this procedure during their orientation to the area.

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Related Policies, Procedures, Guidelines and Legislation

Policies Clinical Handover Procedure Health care Associated Infections, Clinical Procedure Patient identification and Procedure Matching Vital Signs & Early Warning Scores, Clinical Procedure

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References

1. De-Wahl Granelli AD-W, Wennergen M, Sandberg K, Mellander M, Bejlum C, Inganas L, Erikaon M, Segerdahl, agren A, Ekman-Joelsson B-M, Sunnegardh, Verdicchio M and Ostman-Smith I. (2009) Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns. BMJ; 337:a3037

2. Mahle, WT, Newburger JW, matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH (III), Grosse SD. (2009) American Heart Association Congential Heart Defects Committee of the Council on Cardiovascular disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on quality of Care and Outcomes Research. American academy of Pediatrics section on Cardiology and Cardiac surgery. Committee on Fetus and Newborn. Role of Pulse Oximetry in Examining Newborns for Congenital heart Disease:A Scientific Statement from the AHA and AAP. Pediatrics. 124(2):823-836.

3. Meberg A, Andreassen, Brunvand L, Markestad T, Moster D, Nietsch L, Silberg IE and Skalevik JE. (2008) Pulse oximetry screening as a complementary strategy to detect critical congenital heart defects. Acta Paediatrica

4. Thangaratinam S, Brown K, Zamors X, Khan K, and Ewer A (2012). Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. The Lancet Volume 379, Issue 9835, 2459-2464

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Definition of Terms

NICU Neonatal Intensive Care UnitSCN Special Care NurserySpO2 pulse oxygen saturation

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Search Terms

Neonatal Intensive Care, Maternity, Infant, newborn, Neonate, Oximetry, Pulse Oximetry, Cardiac, Congenital

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 16/03/2018 Complete Review Lix Chatham, ED WY&C CHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS14/035 Pulse Oximetry Screening - Neonates

Doc Number Version Issued Review Date Area Responsible PageCHHS18/106 1 16/03/2018 01/04/2021 WY&C – Dept of

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register