![Page 1: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/1.jpg)
1
![Page 2: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/2.jpg)
22
Congenital Heart Disease Screening Program
November, 2011
![Page 3: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/3.jpg)
33
“Over the eleven years since I started C.H.I.N., hardly a day goes by when I do not hear from a distraught parent whose child was not diagnosed at birth, leading to tragic or serious
life-long consequences”
Mona Barmash, President of Children’s Heart Information NetworkJCCHD Meeting, Fall 2007
A Parent’s Perspective
![Page 4: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/4.jpg)
44
♥ Congenital heart disease (CHD) is the most common birth defect and occurs in 8 per 1,000 live births
♥ Critical CHD – Forms of CHD that are usually associated with hypoxia in the newborn period and require intervention during the first months of life
♥ Critical CHD accounts for approximately 1/3 of all CHD1
Congenital Heart Disease
![Page 5: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/5.jpg)
55
Congenital Heart Disease
CHD is important cause of morbidity & mortality in infants:
♥ Accounts for approximately 40% of deaths from congenital anomalies2
♥ Majority of deaths occur among infants during the first year of life2
♥ 10% of infants who died with CHD before one year of age were first diagnosed with CHD at the time of autopsy3
![Page 6: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/6.jpg)
66
Congenital Heart Disease
♥ Over the past 40 years there have been improvements in survival due to improved surgical outcomes
♥ There is still room for improvements in the detection of critical CHD
0%10%20%30%40%50%60%70%80%90%
100%
Prenatal
DeathLateClinicalPrenatal
![Page 7: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/7.jpg)
77
Why is CCHD Missed?
Visual recognition of cyanosis is difficult
Mean threshold for detection 69% 4
![Page 8: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/8.jpg)
88
Pulse Oximetry
♥ A painless and non-invasive way of measuring the oxygen saturation of hemoglobin in the arterial blood.
♥ Routine to clinical care, often thought of as the 5th vital sign.
© Masimo Corporation 2011
![Page 9: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/9.jpg)
99
Pulse Oximetry
How Does Pulse Oximetry Work?
♥ Dependent on Heart Beat as arterial blood vessels contract/expand with each HB
♥ Red (R) and Infrared (IR) Light are transmitted via Light Emitters to a Photodetector
♥ Oxygenated and Deoxygenated Hb absorb different amounts of both R and IR light
♥ A ratio of the light absorbed by the photodetector correlates for oxygen saturation of hemoglobin in the arterial blood
![Page 10: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/10.jpg)
1010
Pulse Oximetry as a Screening Method
Normal Heart
No Mixing of Systemic and
Pulmonary Venous Blood
Flow
Saturation of100 %
![Page 11: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/11.jpg)
1111
Fetal Circulation
Saturation of 98%
PDA
![Page 12: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/12.jpg)
1212
Transposition of the Great Arteries
Saturation of65%
TGA
![Page 13: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/13.jpg)
1313
Pulse Oximetry as Screening Method
♥ Highest sensitivity (true positives) and highest specificity (true negatives) associated with screening the right hand and one foot, using a cut-off of less than 95% or a greater than 3% difference between the two 5
♥ Best outcomes may be found when physical examination is paired with pulse oximetry screening.
♥ September 21, 2011- Health and Human Services Secretary Kathleen Sebelius endorsed adding screening for CCHD to the recommended universal screening panel 6
![Page 14: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/14.jpg)
1414
Congenital Heart Disease Screening Program
VisionAll infants with critical congenital heart
disease are detected before leaving the newborn nursery.
![Page 15: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/15.jpg)
1515
Congenital Heart Disease Screening Program
Program Aims:♥ Implement pulse oximetry
screening programs for the detection of critical CHD in newborn nurseries
♥ Minimize obstacles encountered while performing pulse oximetry screening methods
♥ Screen 100% of infants eligible for screening
♥ Detect critical CHD before clinical deterioration of infant
![Page 16: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/16.jpg)
1616
Congenital Heart Disease Screening Program
♥ Who is eligible to be screened?– All infants that are at least 24 hours of age
♥ How will mothers be educated about screening?– Prenatal
• Tours and Prenatal Classes • OB/GYN Clinics• Newsletters and Hospital Websites
– Postnatal • Prior to screening
![Page 17: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/17.jpg)
1717
Placement of Pulse Oximetry Probe
“Star to the Sky” “Raise the (Red) Bar”
Application with Reusable Probe
Application with Disposable Probe
© Masimo Corporation 2011
![Page 18: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/18.jpg)
1818
Congenital Heart Disease Screening Program
Screening Protocol 7, 8
![Page 19: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/19.jpg)
1919
Recommendations for Follow Up
![Page 20: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/20.jpg)
2020
UE Sat - 100% LE Sat - 96%a. PASSb. FAIL
Example 1
![Page 21: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/21.jpg)
2121
UE Sat - 100% LE Sat - 96%a. PASSb. FAIL
Example 1
![Page 22: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/22.jpg)
2222
2nd Screen:UE Sat – 99%LE Sat – 98% • PASS• FAIL
Example 1
![Page 23: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/23.jpg)
2323
2nd Screen:UE Sat – 99%LE Sat – 98% • PASS• FAIL
Example 1
![Page 24: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/24.jpg)
2424
UE Sat - 96% LE Sat - 94%a. PASSb. FAIL
Example 2
![Page 25: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/25.jpg)
2525
UE Sat - 96% LE Sat - 94%a. PASSb. FAIL
Example 2
![Page 26: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/26.jpg)
2626
UE Sat - 89% LE Sat - 87%a. PASSb. FAIL
Example 3
![Page 27: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/27.jpg)
2727
UE Sat - 89% LE Sat - 87%a. PASSb. FAIL
Example 3
![Page 28: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/28.jpg)
2828
UE Sat - 92% LE Sat - 96%a. PASSb. FAIL
Example 4
![Page 29: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/29.jpg)
2929
UE Sat - 92% LE Sat - 96%a. PASSb. FAIL
Example 4
![Page 30: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/30.jpg)
3030
2nd ScreenUE Sat - 92% LE Sat - 94%a. PASSb. FAIL
Example 4
![Page 31: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/31.jpg)
3131
2nd ScreenUE Sat - 92% LE Sat - 94%a. PASSb. FAIL
Example 4
![Page 32: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/32.jpg)
3232
3rd ScreenUE Sat - 92% LE Sat - 92%a. PASSb. FAIL
Example 4
![Page 33: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/33.jpg)
3333
3rd ScreenUE Sat - 92% LE Sat - 92%a. PASSb. FAIL
Example 4
![Page 34: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/34.jpg)
3434
Congenital Heart Disease Screening Program
Questions?
Elizabeth Bradshaw, MSN, RN, [email protected]
Gerard R. Martin, MD, FAAP, [email protected]
www.childrensnational.org/pulseox
![Page 35: Congenital Heart Disease Congenital Heart Disease CHD is important cause of morbidity & mortality in infants: ♥Accounts for approximately 40% of deaths from congenital anomalies](https://reader033.vdocuments.site/reader033/viewer/2022051802/5ae84d157f8b9a9e5d9064dd/html5/thumbnails/35.jpg)
3535
Congenital Heart Disease Screening Program
References
1. Hoffman, J.I.E., Kaplan, S. (2002). The incidence of congenital heart disease. Journal of the American College of Cardiology, 39, 1890-1900.
2. Boneva, R.S., Botto, L.D., Moore, C.A. Yang, Q., Correa, A., Erickson, J.D. (2001). Mortality associated with congenital heart defects in the United States: Trends and racial disparities, 1979-1997. Circulation, 103, 2376-2381.
3. Kuehl, K.S., Loffredo, C.A., Ferencz, C. (1999). Failure to diagnose congenital heart disease in infancy. Pediatrics, 103(4), 743-747.
4. Hokanson, J.S. Pulse Oximetry Screening for Unrecognized Congenital Heart Disease in Neonates.Congenital Cardiology Today. 2011; 9(1).
5. Granelli, A.D., Wennergren, M., Sandberg, K., Mellander, M., Bejlum, C., Inganas, L., Eriksson, M., Segerdahl, N., Agren, A.,Ekman-Joelsson, B.M., Sunnegardh, J., Verdicchio, M. & Ostman-Smith, O. (2008). 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
6. Sebelius, K. Letter to R. Rodney Howell, M.D [Internet]. 2011 [updated 2011 Sept 21; cited 2011 Sept 23]. Available from: http://www.hrsa.gov/advisorycommittees /mchbadvisory/heritabledisorders
7. Kemper, A.R, Mahle, W.T., Martin, G.R., Cooley, W.C., Kumar, P., Morrow, R.W. et al. Strategies for Implementing Screening for Critical Congenital Heart Disease: Recommendations of the United States Health and Human Services Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children.
8. Children’s National Medical Center. Congenital Heart Disease Screening Program Toolkit: A Toolkit for Implementing Screening. Washington, DC: Children’s National Medical Center; 2009.
.