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Am J Perinatol 2017; 34(09): 856-860
DOI: 10.1055/s-0037-1599214
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Texas Pulse Oximetry Project: A Multicenter Educational and Quality Improvement Project for Implementation of Critical Congenital Heart Disease Screening Using Pulse Oximetry

Charleta Guillory
1   Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
,
Alice Gong
2   Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
,
Judith Livingston
2   Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
,
Liza Creel
3   Department of Health Management and Systems Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky
,
Elena Ocampo
4   Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
,
Tiffany McKee-Garrett
1   Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

12 August 2016

19 January 2017

Publication Date:
06 March 2017 (online)

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Abstract

Objective Critical congenital heart disease (CCHD) is a leading cause of death in infants. Newborn screening (NBS) by pulse oximetry allows early identification of CCHD in asymptomatic newborns. To improve readiness of hospital neonatal birthing facilities for mandatory screening in Texas, an educational and quality improvement (QI) project was piloted to identify an implementation strategy for CCHD NBS in a range of birthing hospitals.

Study Design Thirteen Texas hospitals implemented standardized CCHD screening by pulse oximetry. An educational program was devised and a tool kit was created to facilitate education and implementation. Newborn nursery nurses' knowledge was assessed using a pre- and posttest instrument.

Results The nurses' knowledge assessment improved from 71 to 92.5% (p < 0.0001). Of 11,322 asymptomatic newborns screened after 24 hours of age, 11 had a positive screen, with 1 confirmed case of CCHD. Pulse oximetry CCHD NBS had sensitivity of 100%, specificity of 99.91%, false-positive rate of 0.088%, positive predictive value of 9.09%, and negative predictive value of 100%.

Conclusion Our educational program, including a tool kit, QI processes, and standardized pulse oximetry CCHD NBS, is applicable for a range of hospital birthing facilities and may facilitate wide-scale implementation, thereby improving newborn health.

Keywords

education - quality improvement - pulse oximetry - newborn screening
 

  • References

  • 1 Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 2012; 379 (9835): 2459-2464
    CrossrefPubMedGoogle Scholar
  • 2 Chang RK, Gurvitz M, Rodriguez S. Missed diagnosis of critical congenital heart disease. Arch Pediatr Adolesc Med 2008; 162 (10) 969-974
    CrossrefPubMedGoogle Scholar
  • 3 Riede FT, Wörner C, Dähnert I, Möckel A, Kostelka M, Schneider P. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine—results from a prospective multicenter study. Eur J Pediatr 2010; 169 (08) 975-981
    CrossrefPubMedGoogle Scholar
  • 4 Frank LH, Bradshaw E, Beekman R, Mahle WT, Martin GR. Critical congenital heart disease screening using pulse oximetry. J Pediatr 2013; 162 (03) 445-453
    CrossrefPubMedGoogle Scholar
  • 5 Sebelius K. Letter to R. Rodney Howell. http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders . Updated September 21, 2011 . Accessed July 15, 2014
    PubMedGoogle Scholar
  • 6 Newborn screening congenital heart defects. Association of State and Territorial Health Officials. http://www.astho.org/public-policy/state-health-policy/newborn-screening-heart-defects-map . Updated March 6, 2014 . Accessed July 15, 2014
    PubMedGoogle Scholar
  • 7 Mahle WT, Martin GR, Beekman III RH, Morrow WR. ; Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics 2012; 129 (01) 190-192
    CrossrefPubMedGoogle Scholar
  • 8 Kemper AR, Mahle WT, Martin GR. , et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128 (05) e1259-e1267
    CrossrefPubMedGoogle Scholar
  • 9 Mahle WT, Newburger JW, Matherne GP. , et al; American Heart Association Congenital 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, and Committee on Fetus and Newborn. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120 (05) 447-458
    CrossrefPubMedGoogle Scholar
  • 10 Bradshaw EA, Cuzzi S, Kiernan SC, Nagel N, Becker JA, Martin GR. Feasibility of implementing pulse oximetry screening for congenital heart disease in a community hospital. J Perinatol 2012; 32 (09) 710-715
    CrossrefPubMedGoogle Scholar
  • 11 Resources for health care providers. Children's National Medical Center. http://www.childrensnational.org/PulseOx/HealthCareProvidersResources.aspx . Accessed February 21, 2017
    PubMedGoogle Scholar
  • 12 Farner R, Livingston J, Rubio SA, Gutierrez MV, Gong A. ; Texas Pulse Oximetry Project Team. The nurse champion model for advancing newborn screening of critical congenital heart disease. J Obstet Gynecol Neonatal Nurs 2014; 43 (04) 497-506
    CrossrefPubMedGoogle Scholar
  • 13 Texas Pulse Oximetry Project. Texas Pediatric Society. http://www.txpeds.org/txpop . Accessed February 21, 2017
    PubMedGoogle Scholar
  • 14 Newborn screening for critical congenital heart disease in Texas. Texas Department of State Health Services Website. http://www.dshs.state.tx.us/newborn/cchdtoolkit/ . Updated May 29, 2014 . Accessed February 21, 2017
    PubMedGoogle Scholar
  • 15 Kaltman JR, Burns KM, Pearson GD. Screening in pediatrics-more questions than answers?. J Pediatr 2013; 162 (03) 454-456
    CrossrefPubMedGoogle Scholar
  • 16 Trotter TL, Fleischman AR, Howell RR, Lloyd-Puryear M. ; Secretary's Advisory Committee on Heritable Disorders in Newborns and Children. Secretary's Advisory Committee on Heritable Disorders in Newborns and Children response to the President's Council on Bioethics report: the changing moral focus of newborn screening. Genet Med 2011; 13 (04) 301-304
    CrossrefPubMedGoogle Scholar
  • 17 Studer MA, Smith AE, Lustik MB, Carr MR. Newborn pulse oximetry screening to detect critical congenital heart disease. J Pediatr 2014; 164 (03) 505-509.e1 , 2
    CrossrefPubMedGoogle Scholar