Results and Responsibilities

Screening results

The infant is screen negative if the pulse oximetry is greater than or equal to 95% in the right hand or either foot with less than or equal to 3% difference in oxygen saturation between the right hand and foot. No further screening is required.

The infant must be referred to a physician urgently if:

the pulse oximetry is less than 90% in the right hand or either foot at any stage of screening

OR

the pulse oximetry is less than 95% on both extremities, or the pulse oximetry difference in oxygen saturation is greater than 3% between the right hand and either foot for 3 consecutive measures each separated by 1 hour

When the infant has a screen positive result, the most responsible provider is to be notified of the screen positive result. In addition, the infant should be referred to a physician for further investigation.

Green = Pass (screen complete)
Yellow = Repeat in 1 hour (max 2 repeats)
Red = Physician assessment required

Evaluation of pulse oximetry results

The pre- and post-ductal values are compared using the CCHD Screening Algorithm or the evaluation chart (to the right) to determine the screening.

In order to pass (screen negative):

Both values must be over 90, (If a value is below 90, the infant must be referred immediately)
at least one of the values must be 95 or over, and
the difference between the 2 values must be 3% or less

Based on our CCHD Screening Algorithm, if the infant does not pass on the first pluse oximetry screen and has both saturations above 90, repeat the screen in one hour. This is considered a “repeat” result.
If a “repeat” result is obtained a second time (with both values over 90), repeat the screen again in one hour.
If a pass result is not obtained on the third attempt, the infant should be referred to a physician for further investigation.

When evaluating the saturation values, do not ignore the rest of the clinical picture. CCHD pulse oximetry is a screening process, intended to be completed on well infants. If an infant is demonstrating clinical symptoms, assessment and evaluation must begin immediately.

Screen positive (refer) result responsibilities

Submitter:

The physician should perform a physical exam of the infant, including:

a four limb blood pressure,
femoral pulses,
full vital signs,
pre- and post-ductal saturations.

The physician may also order diagnostic investigations including an ECG, chest X-Ray and other tests to rule out other non-cardiac causes. If cardiac diagnosis cannot be confidently ruled out, NSO recommends consultation with a paediatric cardiologist or paediatrician/neonatologist for further investigation.

If an infant has a screen positive result in an out of hospital environment, an urgent consultation to a physician for assessment should be arranged by the infant’s most responsible health care provider.

Newborn Screening Ontario (NSO):

When a screen positive result is received by NSO, NSO will call the health care providers involved in the infant’s care to ensure that appropriate follow-up occurred. NSO will complete a Diagnostic Evaluation Report Form (DERF) for the infant, documenting the interventions, outcome, and diagnosis (as information is available).