Pulse Oximetry Screening in Wisconsin

Abstract

Introduction. Pulse oximetry can be used as a screening tool to detect critical congenital heart disease (CCHD) in neonates prior to hospital discharge and the development of symptoms. Newborns suspected of having CCHD based on pulse oximetry screening should have the diagnosis excluded or confirmed with echocardiography. However, echocardiography is not immediately available in all settings in which newborns are delivered and the best course of action in these settings remains to be determined. The purpose of this study was to evaluate the resources available to diagnose and treat newborns with CCHD born in the state of Wisconsin. Methods. We surveyed the nurse managers or administrators of the 99 Wisconsin hospitals in which babies are routinely delivered in the state of Wisconsin. A telephone survey was performed in February and March 2011. The number of births per facility was estimated from the most recent available data (2010).Results. There were 66 179 total births occurring in 106 hospitals in the state of Wisconsin in 2010, with 99 hospitals routinely delivering newborns. Surveys were completed in 88/99 (88.9%), representing 95% of the state's in-hospital births. All responding hospitals had pulse oximetry available in the nursery. Twenty-five of 88 (28.4%) of responding hospitals routinely use pulse oximetry to screen for CCHD, representing 35.2% of surveyed hospital births. Same-day neonatal echocardiography was available at 33/88 (37.5%) of the responding hospitals, representing 74.4% of surveyed hospital births. The average distance to the higher-level care facility of choice from the hospitals without neonatal echocardiography is 53.1 miles. Conclusion. Pulse oximetry is universally available in Wisconsin newborn nurseries, and pulse oximetry screening for CCHD is currently being performed for many of Wisconsin's newborns. The majority of births in Wisconsin occur in hospitals where same-day neonatal echocardiography is available for confirmatory diagnosis of CCHD when necessary.

Implementation of Critical Congenital Heart Disease Screening in Minnesota

“…The state' s current infrastructure for CCHD screening and pediatric cardiology support covers ∼85% of the state' s hospital births, which is comparable to data from Wisconsin. 11 Disparities between resources for CCHD screening and follow-up in metropolitan centers, centers affiliated with a large health care system, and rural independent centers exist, but overall, the survey suggests that the state is adequately prepared and equipped for implementation of CCHD screening. However, only twothirds of newborns are born in an NBN that is adequately prepared to manage an infant with CCHD.…”

Screening for Critical Congenital Heart Disease in Newborns

“…In contrast to a state like New Jersey, which has a large population in a smaller geographic area, a state like Wisconsin may encounter the situation of limited access to further evaluation for CCHD more readily. Approximately one-quarter of hospitals in the state of Wisconsin would have to transport newborn infants an average of more than 50 miles to obtain further cardiology evaluation after a positive pulse oximetry screen result [38]. This situation would result in potentially additional stress for the family in addition to separating a mother and child shortly after birth.…”

Lessons Learned From Newborn Screening for Critical Congenital Heart Defects

“…A child who has not passed the screening by the third testing is considered to have failed. Most states and hospital systems adopted this protocol, and many have reported their experiences to date, including Minnesota, 15, 16 Washington, 17 California, 18 Arkansas, 19 Wisconsin, 20 Maryland, 21 and Vermont. 22 …”