医学专题—新生儿先天性心脏病筛查.pptx

《医学专题—新生儿先天性心脏病筛查.pptx》由会员分享，可在线阅读，更多相关《医学专题—新生儿先天性心脏病筛查.pptx（25页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、NewbornScreeningforCriticalCongenitalHeartDiseaseEducationforNurses第一页，共二十五页。ThepurposeoftheCongenitalHeartDisease(CHD)ScreeningProgramistoidentifynewbornswithCHDpriortoclinicaldeteriorationoftheaffectedinfant.Delayeddiagnosisofcriticalcongenitalheartdisease(CCHD)canresultindeathorinjurytoinfants.Wh

2、ydoweneedtoscreen?第二页，共二十五页。TheDepartmentofHealthandHumanServiceshereintheUnitedStatesmadethisCHD(also called CCHDCritical Congenital Heart Disease)screeningrecommendationSeptemberof2011.InJanuaryofthisyear,theAmericanAcademyofPediatricsendorsedthisrecommendation.OurOBPEDSteamhasrecentlyapprovedthep

3、olicyandwearereadytogetstartednow!Wehadsomequestionstoansweraboutnewbornechocardiogramsbeforewecouldgetstarted!Whoendorsesthis?第三页，共二十五页。Congenitalheartdefects(CHDs)accountfor24%ofinfantdeathsduetobirthdefects.IntheUnitedStates,about4,800(or11.6per10,000)babiesborneveryyearhaveoneofsevencritical con

4、genital heart defects(CCHDs,whichalsoareknowncollectivelyinsomeinstancesascritical congenital heart disease).CCHDFactSheet第四页，共二十五页。Sevenofthemost common CRITICALCONGENITALHEARTDEFECTSare:HypoplasticLeftHeartPulmonaryAtresiaTetralogyofFallotTranspositionoftheGreatArteriesTricuspidAtresiaTruncusArter

5、iosusTotalAnomalousPulmonaryvenousReturnWhatareCCHDs?第五页，共二十五页。BabieswithoneoftheseCCHDsareatsignificantriskofdisabilityordeathiftheirCCHDisnotdiagnosedsoonafterbirth.ThesesevenCCHDsamongsomebabiespotentiallycanbedetectedusingpulse oximetry screening,whichisatesttodeterminetheamountofoxygeninthebloo

6、dandpulserate.SevenCommonCCHDs第六页，共二十五页。Somebabiesbornwithaheartdefectcanappearhealthyatfirstandcanbesenthomewiththeirfamiliesbeforetheirheartdefectisdetected.Ithasbeenestimatedthatatleast280infantswithanunrecognizedCCHDaredischargedeachyearfromnewbornnurseriesintheUnitedStates.Thesebabiesareatriskf

7、orhavingseriouscomplicationswithinthefirstfewdaysorweeksoflifeandoftenrequireemergencycare.WhyisthisImportant?第七页，共二十五页。NewbornscreeningusingpulseoximetrycanidentifysomeinfantswithaCCHDbeforetheyshowsignsofaCCHD.Onceidentified,babieswithaCCHDcanbeseenbycardiologistsandcanreceivespecializedcareandtre

8、atmentthatcouldpreventdeathordisabilityearlyinlife.Treatmentcanincludemedicationsandsurgery.WhyPulseOximetry?第八页，共二十五页。Pulseoximetryisasimplebedsidetesttodeterminetheamountofoxygeninababysbloodandthebabyspulserate.LowlevelsofoxygeninthebloodcanbeasignofaCCHD.Screeningisdonewhenababyis24 to 48 hours

9、of age,oraslateaspossibleifthebabyistobedischargedfromthehospitalbeforeheorsheis24hoursofage.Pulseoximetryscreeningdoesnotreplaceacompletehistoryandphysicalexamination.Whenarebabiesscreened?第九页，共二十五页。MakethenewborniswarmandquietKnowhowtocorrectlyusetheequipmentandwheretogetsupplies.Makesureyouareget

10、tingaccuratereadingsbyassuringagoodwaveformandheartrateonthemonitor.ALWAYSusetherighthandandrightfootPractice!HowcanIhavethemostsuccess?第十页，共二十五页。RightHandandRightFootWheredoperformthetestonthebaby?第十一页，共二十五页。Anurseshouldperformthetestafter24hoursofageorascloseaspossibletodischargeALL NEWBORNS WILL

11、BE SCREENED UsetheAlgorithmstodeterminewhattodo.Thereisapassingalgorithmandafailingalgorithm.Whoperformsthetest?第十二页，共二十五页。1.PlaceO2SatProbeonthenewbornsrighthandorrightfootfirst.O2satprobesareachargeitemandinPyxis.Thereare2sizestochoosefromNeo-LandInf-L,bothmadebyMasimo.2.Recordthereadingandthenswi

12、tchtowhateverextremityyoudidntstartwith.ONLYscreenRight hand and Right foot.StepOne第十三页，共二十五页。IftheNewbornssaturationisgreaterthanorequalto95%inEITHERextremitywithalessthanorequalto3%differencebetweenthetwo,thewillbeconsideredaPASS.NoadditionalevaluationwillberequiredunlesssignsandsymptomsofCHDarepr

13、esent.Results第十四页，共二十五页。PulseOx 95%(RHORRF)andDifferenceof 3%BetweenRHandRFPASSNormalNewbornCarePassingAlgorithmPassing Algorithm:第十五页，共二十五页。IftheoxygenSaturationsarelessthan95%inboththehandandfootorthereisgreaterthan3%differencebetweenthetwoonthreemeasureseachseparatedbyonehour,thenewbornshouldbere

14、ferredforadditionalevaluation.Ifthenewbornssaturationislessthan90%ineitherthehandorfoot,heorsheshouldbeimmediatelyreferredforadditionalevaluation.“Failing”Results第十六页，共二十五页。PulseOx3%betweenRHANDRF.PASSFAILRepeatPulseOxin1hourPASSFAILRepeatPulseOxin1hourPASSFAILClinicalAssessmentandCallPhysicianFaili

15、ngAlgorithm第十七页，共二十五页。Ifyouhaveafailingresultafterthethirdscreening:qNotifythePhysicianqInfectiousandpulmonarypathologyshouldbeexcludedqCompleteechocardiogramasdirectedbytheinfantsphysician.qIfinfantissymptomatic,CALLphysicianimmediately!Whatnext?第十八页，共二十五页。YES,wecan.JamieinRadiologyisgettingtrained

16、CURRENTLY!Shehasbeenworkingonthisforafewmonths.Shehastogetherpracticeinbeforesheisonherown.Youwillsoonseeinformationaboutgettingherpracticenewborns!Canwedoechocardiogramshere?第十九页，共二十五页。RecordtheResultsontheCongenitalHeartDiseaseScreeningProgramForm.(clickhere)Alsocheck off theDischargeChecklist-Bab

17、yinMeditechwhenitiscomplete.WheretoRecordResults第二十页，共二十五页。Pleaseclickhere:Whattowetellpatients?第二十一页，共二十五页。PleaseclickheretoaccessthepolicyIsthereaPolicy?第二十二页，共二十五页。Donthesitatetoaskquestions!Thank-you!第二十三页，共二十五页。AmericanAcademyofPediatricsPolicyStatement.Pediatrics.Volume129,Number1,January2012.Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease.References第二十四页，共二十五页。内容(nirng)总结Newborn Screening for Critical Congenital Heart Disease。What are CCHDs。References第二十五页，共二十五页。