POLICY/PROCEDURE TITLE:
UCSD Medical Center:
WOMEN & INFANT SERVICES
POSTDUCTAL OXYGEN
SATURATION (POS) SCREENING
OF HEALTHY NEWBORNS
RELATED TO:
ADMINISTRATIVE
Medical Center Policy (MCP)
Nursing Practice Stds.
JCAHO
Patient Care Stds.
QA
Other
Effective date: 9/10
Review date:
CLINICAL
PAGE 1 OF _
Revision date:
Unit/Department of Origin: FMCC
Other Approval: ISCC
Title 22
KEY ELEMENTS:
1. Critical congenital heart defects (CCHD) occur in 2 per 1000 live births.
2. Antenatal ultrasound screening picks up many but not all heart defects in the fetus and the
newborn physical exam may miss up to 50% of CCHD.
3. Up to 30 infants die of a missed or possibly late diagnosis of CCHD in California each year.
4. CCHD lesions are often dependent on the ductal blood flow, and when the duct closes, the
infant has poor perfusion of vital organs and is at high risk of quickly becoming very ill.
5. POS screening may detect unknown CCHD’s. Although, a negative test result does not
exclude the possibility of heart disease.
6. Early detection and treatment would allow these babies to be stabilized prior to corrective
surgery.
POLICY STATEMENT:
1. All unmonitored newborns will have a postductal oxygen saturation (POS) screen prior to
discharge.
(Definition of postductal: relating to that part of the aorta distal to the aortic opening of the
ductus arteriosus; postductal saturations are obtained on the left hand or either foot.)
2. Normal newborn postductal oxygen saturation should be > 95% soon after birth.
3. A postductal oxygen saturation < 95% can indicate abnormal mixing of oxygenated and
deoxygenated blood
4. Infants who are found to have oxygen saturation < 95% require further evaluation.
5. Infants located in the Infant Special Care Center will have a postductal oxygen saturation
(POS) screen prior to transfer or discharge.
RESPONSIBLE PARTY:
RN, NP, MD
EQUIPMENT: Oximeter, Oximeter probe, Stethoscope
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PROCEDURE:
FMCC/Birth Center:
1. The POS screen will be done by the pediatric medical provider during the first newborn
exam; preferably between 4 and 24 hours of life. Infants that were monitored in the ISCC
and have a documented post ductal saturation > 95% will not need additional screening.
2. Clean the oxygen sensor with alcohol prior to use.
3. For infants < 3kg, the oxygen sensor will be used with the Nellcor A/N Sensor Wrap around
the infant’s foot. Assure that the foot is clean and dry prior to sensor placement.
4. For infants > 3 kg on FMCC and the Birth Center, the Nellcor Pedicheck D-YSPD clip will be
used on the infant’s big toe. Assure that the foot is clean and dry prior to sensor placement.
Please see diagram below for correct fit. The sensor should fit around the infant’s toe as
illustrated in picture (c) or (d).
5. As the accuracy of saturation readings is affected by motion, the infant should remain as
quiet as possible. It may be necessary to have the parent hold the infant throughout the
procedure.
6. The accuracy of saturation readings may also be affected by ambient light, covering the
infant’s extremity with a blanket may help minimize light interference. If the infant is on
phototherapy, please turn off the lights during the procedure to decrease ambient light.
7. Observe the infant’s saturation for one minute, saturations should be > 95%.
8. Infants who have an oxygen saturation of < 95% for more than 10 seconds will be placed on
the monitor in the Newborn Procedure Room with a disposable oxygen sensor.
9. If the infant continues to have an oxygen saturation < 95% he/she will need to be transferred
to ISCC for further management.
10. Pass results will be documented on the Newborn Record by the pediatric provider.
ISCC:
1. RNs responsible for the care of the infant located in the Infant Special Care Center will
obtain a postductal oxygen saturation prior to transfer or discharge.
2. Results will be documented in PCIS. Results of the the POS screen will be found in the vital
sign section under “Saturation Screening”.
3. Abnormal screens (saturation < 95%) will be reported to the ISCC pediatric provider for
further work up and management.
REFERENCES:
Koppel RI, Druschel CM, Carter T, et al. Effectiveness of pulse oximetry screening for
congenital heart disease in asymptomatic newborns. Pediatrics 2003; 111:451-455
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Mahle, W.T. et al. Role of Pulse Oximetry in Examining Newborns for Congenital Heart
Disease: A Scientific Statement from the AHA and AAP. Peridatrics 2009; 124; 823-836. July 6,
2009.
Nellcor Oximax Dura-Y, Multiple Oxygen Sensor instruction manual, Tyco Healthcare Group, LP
Valmari P. Should pulse oximetry be used to screen for congenital heart disease? Arch Dis
Child Fetal Neonatal ed.2007; 92: 219-224
Sendelbach DM, Jackson GL, Lai SS. Pulse oximetry screening at 4 hours of age to detect
critical congenital heart defects. Pediatrics 2008; 112:e815-820; originally published online Sep
1, 2008
Schultz AH, Localio AR, Clark BJ et al. Epidemiologic features of the presentation of critical
congenital heart disease: implications for screening. Pediatrics 2008; 121: 751-757
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