2022年医学专题—新生儿先天性心脏病筛查(1).pptx

Newborn Screening for Critical Congenital Heart Disease,Education for Nurses,第一页，共二十五页。,The purpose of the Congenital Heart Disease(CHD)Screening Program is to identify newborns with CHD prior to clinical deterioration of the affected infant.Delayed diagnosis of critical congenital heart disease(CCHD)can result in death or injury to infants.,Why do we need to screen?,第二页，共二十五页。,The Department of Health and Human Services here in the United States made this CHD(also called CCHDCritical Congenital Heart Disease)screening recommendation September of 2011.In January of this year,the American Academy of Pediatrics endorsed this recommendation.Our OB PEDS team has recently approved the policy and we are ready to get started now!We had some questions to answer about newborn echocardiograms before we could get started!,Who endorses this?,第三页，共二十五页。,Congenital heart defects(CHDs)account for 24%of infant deaths due to birth defects.In the United States,about 4,800(or 11.6 per 10,000)babies born every year have one of seven critical congenital heart defects(CCHDs,which also are known collectively in some instances as critical congenital heart disease).,CCHD Fact Sheet,第四页，共二十五页。,Seven of the most common CRITICAL CONGENITAL HEART DEFECTS are:Hypoplastic Left HeartPulmonary AtresiaTetralogy of FallotTransposition of the Great ArteriesTricuspid AtresiaTruncus ArteriosusTotal Anomalous Pulmonary venous Return,What are CCHDs?,第五页，共二十五页。,Babies with one of these CCHDs are at significant risk of disability or death if their CCHD is not diagnosed soon after birth.These seven CCHDs among some babies potentially can be detected using pulse oximetry screening,which is a test to determine the amount of oxygen in the blood and pulse rate.,Seven Common CCHDs,第六页，共二十五页。,Some babies born with a heart defect can appear healthy at first and can be sent home with their families before their heart defect is detected.It has been estimated that at least 280 infants with an unrecognized CCHD are discharged each year from newborn nurseries in the United States.These babies are at risk for having serious complications within the first few days or weeks of life and often require emergency care.,Why is this Important?,第七页，共二十五页。,Newborn screening using pulse oximetry can identify some infants with a CCHD before they show signs of a CCHD.Once identified,babies with a CCHD can be seen by cardiologists and can receive specialized care and treatment that could prevent death or disability early in life.Treatment can include medications and surgery.,Why Pulse Oximetry?,第八页，共二十五页。,Pulse oximetry is a simple bedside test to determine the amount of oxygen in a babys blood and the babys pulse rate.Low levels of oxygen in the blood can be a sign of a CCHD.Screening is done when a baby is 24 to 48 hours of age,or as late as possible if the baby is to be discharged from the hospital before he or she is 24 hours of age.Pulse oximetry screening does not replace a complete history and physical examination.,When are babies screened?,第九页，共二十五页。,Make the newborn is warm and quietKnow how to correctly use the equipment and where to get supplies.Make sure you are getting accurate readings by assuring a good wave form and heart rate on the monitor.ALWAYS use the right hand and right footPractice!,How can I have the most success?,第十页，共二十五页。,Right Hand and Right Foot,Where do perform the test on the baby?,第十一页，共二十五页。,A nurse should perform the test after 24 hours of age or as close as possible to dischargeALL NEWBORNS WILL BE SCREENED Use the Algorithms to determine what to do.There is a passing algorithm and a failing algorithm.,Who performs the test?,第十二页，共二十五页。,1.Place O2 Sat Probe on the newborns right hand or right foot first.O2 sat probes are a charge item and in Pyxis.There are 2 sizes to choose from Neo-L and Inf-L,both made by Masimo.2.Record the reading and then switch to whatever extremity you didnt start with.ONLY screen Right hand and Right foot.,Step One,第十三页，共二十五页。,If the Newborns saturation is greater than or equal to 95%in EITHER extremity with a less than or equal to 3%difference between the two,the will be considered a PASS.No additional evaluation will be required unless signs and symptoms of CHD are present.,Results,第十四页，共二十五页。,Passing Algorithm,Passing Algorithm:,第十五页，共二十五页。,If the oxygen Saturations are less than 95%in both the hand and foot or there is greater than 3%difference between the two on three measures each separated by one hour,the newborn should be referred for additional evaluation.If the newborns saturation is less than 90%in either the hand or foot,he or she should be immediately referred for additional evaluation.,“Failing”Results,第十六页，共二十五页。,Pulse Ox 3%between RH AND RF.PASSFAIL Repeat Pulse Ox in 1 hourPASSFAIL Repeat Pulse Ox in 1 hourPASSFAIL Clinical Assessment and Call Physician,Failing Algorithm,第十七页，共二十五页。,If you have a failing result after the third screening:Notify the PhysicianInfectious and pulmonary pathology should