新生儿先天性心脏病筛查.pptx

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1、NewbornScreeningforCriticalCongenitalHeartDiseaseEducationforNursesThepurposeoftheCongenitalHeartDisease(CHD)ScreeningProgramistoidentifynewbornswithCHDpriortoclinicaldeteriorationoftheaffectedinfant.Delayeddiagnosisofcriticalcongenitalheartdisease(CCHD)canresultindeathorinjurytoinfants.Whydoweneedt

2、oscreen?TheDepartmentofHealthandHumanServiceshereintheUnitedStatesmadethisCHD(also called CCHDCritical Congenital Heart Disease)screeningrecommendationSeptemberof2011.InJanuaryofthisyear,theAmericanAcademyofPediatricsendorsedthisrecommendation.OurOBPEDSteamhasrecentlyapprovedthepolicyandwearereadyto

3、getstartednow!Wehadsomequestionstoansweraboutnewbornechocardiogramsbeforewecouldgetstarted!Whoendorsesthis?Congenitalheartdefects(CHDs)accountfor24%ofinfantdeathsduetobirthdefects.IntheUnitedStates,about4,800(or11.6per10,000)babiesborneveryyearhaveoneofsevencritical congenital heart defects(CCHDs,wh

4、ichalsoareknowncollectivelyinsomeinstancesascritical congenital heart disease).CCHDFactSheetSevenofthemost common CRITICALCONGENITALHEARTDEFECTSare:HypoplasticLeftHeartPulmonaryAtresiaTetralogyofFallotTranspositionoftheGreatArteriesTricuspidAtresiaTruncusArteriosusTotalAnomalousPulmonaryvenousReturn

5、WhatareCCHDs?BabieswithoneoftheseCCHDsareatsignificantriskofdisabilityordeathiftheirCCHDisnotdiagnosedsoonafterbirth.ThesesevenCCHDsamongsomebabiespotentiallycanbedetectedusingpulse oximetry screening,whichisatesttodeterminetheamountofoxygeninthebloodandpulserate.SevenCommonCCHDsSomebabiesbornwithah

6、eartdefectcanappearhealthyatfirstandcanbesenthomewiththeirfamiliesbeforetheirheartdefectisdetected.Ithasbeenestimatedthatatleast280infantswithanunrecognizedCCHDaredischargedeachyearfromnewbornnurseriesintheUnitedStates.Thesebabiesareatriskforhavingseriouscomplicationswithinthefirstfewdaysorweeksofli

7、feandoftenrequireemergencycare.WhyisthisImportant?NewbornscreeningusingpulseoximetrycanidentifysomeinfantswithaCCHDbeforetheyshowsignsofaCCHD.Onceidentified,babieswithaCCHDcanbeseenbycardiologistsandcanreceivespecializedcareandtreatmentthatcouldpreventdeathordisabilityearlyinlife.Treatmentcaninclude

8、medicationsandsurgery.WhyPulseOximetry?Pulseoximetryisasimplebedsidetesttodeterminetheamountofoxygeninababysbloodandthebabyspulserate.LowlevelsofoxygeninthebloodcanbeasignofaCCHD.Screeningisdonewhenababyis24 to 48 hours of age,oraslateaspossibleifthebabyistobedischargedfromthehospitalbeforeheorsheis

9、24hoursofage.Pulseoximetryscreeningdoesnotreplaceacompletehistoryandphysicalexamination.Whenarebabiesscreened?MakethenewborniswarmandquietKnowhowtocorrectlyusetheequipmentandwheretogetsupplies.Makesureyouaregettingaccuratereadingsbyassuringagoodwaveformandheartrateonthemonitor.ALWAYSusetherighthanda

10、ndrightfootPractice!HowcanIhavethemostsuccess?RightHandandRightFootWheredoperformthetestonthebaby?Anurseshouldperformthetestafter24hoursofageorascloseaspossibletodischargeALL NEWBORNS WILL BE SCREENED UsetheAlgorithmstodeterminewhattodo.Thereisapassingalgorithmandafailingalgorithm.Whoperformsthetest

11、?1.PlaceO2SatProbeonthenewbornsrighthandorrightfootfirst.O2satprobesareachargeitemandinPyxis.Thereare2sizestochoosefromNeo-LandInf-L,bothmadebyMasimo.2.Recordthereadingandthenswitchtowhateverextremityyoudidntstartwith.ONLYscreenRight hand and Right foot.StepOneIftheNewbornssaturationisgreaterthanore

12、qualto95%inEITHERextremitywithalessthanorequalto3%differencebetweenthetwo,thewillbeconsideredaPASS.NoadditionalevaluationwillberequiredunlesssignsandsymptomsofCHDarepresent.ResultsPulseOx 95%(RHORRF)andDifferenceof 3%BetweenRHandRFPASSNormalNewbornCarePassingAlgorithmPassing Algorithm:IftheoxygenSat

13、urationsarelessthan95%inboththehandandfootorthereisgreaterthan3%differencebetweenthetwoonthreemeasureseachseparatedbyonehour,thenewbornshouldbereferredforadditionalevaluation.Ifthenewbornssaturationislessthan90%ineitherthehandorfoot,heorsheshouldbeimmediatelyreferredforadditionalevaluation.“Failing”

14、ResultsPulseOx3%betweenRHANDRF.PASSFAILRepeatPulseOxin1hourPASSFAILRepeatPulseOxin1hourPASSFAILClinicalAssessmentandCallPhysicianFailingAlgorithmIfyouhaveafailingresultafterthethirdscreening:qNotifythePhysicianqInfectiousandpulmonarypathologyshouldbeexcludedqCompleteechocardiogramasdirectedbytheinfa

15、ntsphysician.qIfinfantissymptomatic,CALLphysicianimmediately!Whatnext?YES,wecan.JamieinRadiologyisgettingtrainedCURRENTLY!Shehasbeenworkingonthisforafewmonths.Shehastogetherpracticeinbeforesheisonherown.Youwillsoonseeinformationaboutgettingherpracticenewborns!Canwedoechocardiogramshere?RecordtheResu

16、ltsontheCongenitalHeartDiseaseScreeningProgramForm.(clickhere)Alsocheck off theDischargeChecklist-BabyinMeditechwhenitiscomplete.WheretoRecordResultsPleaseclickhere:Whattowetellpatients?PleaseclickheretoaccessthepolicyIsthereaPolicy?Donthesitatetoaskquestions!Thank-you!AmericanAcademyofPediatricsPolicyStatement.Pediatrics.Volume129,Number1,January2012.Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease.References