Blood Oxygenation in Newborns: More Complicated Than You Think
Variables That Affect Accuracy
One variable necessary to promote the accuracy of pulse oximetry in newborns is the effect of the closing of the ductus arteriosus on blood oxygenation. This is something that will not have an effect in the newborn until after 24 hours. Therefore, to accurately screen for critical congenital heart disease (CCHD) using pulse oximetry, health care professionals must wait 24 hours after the infant’s birth (Farner, Livingston, Rubio, Gutierrez, & Gong, 2014).
Another variable that affects the accuracy of the screening is the necessity of getting one reading in a preductal area and another reading in a postductal area. It is not enough to simply get one reading, but rather to compare two separate readings and make sure that they are both equal to or greater than 95 percent, and that there is a difference between them that is equal to or less than 3 percent (Farner et al., 2014).
Benefits and Limitations
One benefit would be the reduction of infant mortality as a result of undiagnosed CCHD. According to Farner et al. (2014), as many as 280 infants are discharged from the hospital following delivery without being accurately diagnosed with CCHD. Oximetry screening could help reduce this number.
Another benefit would be raising awareness of the condition. Many people are not aware that such a condition exists, yet 4,800 children are born with it each year (Farner et al., 2014). As such, parents and health care providers are not looking out for signs and symptoms. Screening for the condition using oximetry is not 100 percent accurate. However, it has the added benefit of making people aware of what to look for. In fact, the screening is not a pass fail, but has a criteria for reassessment and observation of the infant should they fall within a certain range. This promotes people to be more vigilant.
One limitation on performing pulse oximetry on all newborns is the training involved. Nurses and other health care professionals have to first be trained on the dangers of CCHD and on how pulse oximetry can help in early detection. There is an algorithm involved that health care providers must use to interpret the results. Also, there are already screening methods used to detect CCHD, so people must be convinced of the benefits of adding in the oximetry screening.
Another limitation is that of legislation. The only true way to get pulse oximetry screenings done on all newborns is to make it mandatory for the health care facility. Legislation is a long process that requires knowledge of both medicine and law. Furthermore, legislation requires proof of concept for the health care model being advocated. So, there must already be a substantial number of facilities performing routine oximetry scans for there to be enough data to make a case. This can be a long slow process that is difficult to gain momentum in the early stages.
Competencies to Improve Outcomes
Evidence based practice is one competency that will greatly improve patient outcomes through oximetry screening. Research must be done on the effectiveness of this method, and much research has already been done on the topic. As more and more data is gathered, stronger cases can be made to state legislatures and hospital administrators for the implementation of regulations and policies that mandate pulse oximetry screenings in newborns. Many states have already passed legislation on this issue, which demonstrates the effectiveness of evidence based practice in promoting this screening method.
Farner, R., Livingston, J., Rubio, S. A., Gutierrez, M. V., & Gong, A. (2014). The Nurse Champion Model for Advancing Newborn Screening of Critical Congenital Heart Disease. Journal of Obstetric, Gynecologic & Neonatal Nursing, 43(4), 497-506.
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