Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 181 - SPECIAL HEALTH PROGRAMS
Chapter 10 - SCREENING OF NEWBORNS FOR CRITICAL CONGENITAL HEART DISEASE
Section 181-10-003 - HOSPITAL AND BIRTHING FACILITY RESPONSIBILITIES

(A) Have and implement policies and procedures consistent with this chapter to screen all newborns for critical congenital heart disease. Screening must be done using pulse oximetry at 24 hours of life or soon after on day 2 of life, or prior to discharge whichever occurs first.

(B) Document that it notified the receiving hospital of the critical congenital heart disease screening results for every newborn transferred. If no results were available, the transferring facility must document it notified the receiving facility that the critical congenital heart disease screen needs to be completed.

(C) Complete screening for critical congenital heart disease using pulse oximetry. The probe and sensors must be placed on the right hand and one foot. If reusable probes and sensors are used, proper sanitation to prevent infection and communicable disease must be maintained. False negatives are possible, so negative screening results must not delay referral for pediatric cardiology evaluation of an infant otherwise suspected of having critical congenital heart disease. The results of all screening must be recorded in the newborn's medical record.

(D) Consider newborns with oxygen saturation percentages of 95 percent or more in the right hand or foot and the difference between the hand and foot is 3 percent or less as having passed the screen.

(E) Consider oxygen saturation percentages between 90 percent and less than 95 percent on both the right hand and foot, or a difference of more than 3 percent between the hand and foot as an inconclusive result. The newborn must not be discharged and must be rescreened in one hour. If the rescreen remains inconclusive a third screen must be done in one hour. If on the third screen the results continue to not meet the pass criteria, this is a failed screen. The hospital or birthing facility must immediately notify the newborn's physician of the failed screen for critical congenital heart disease.

(F) Consider oxygen saturation percentages less than 90 percent on any screen, initial or rescreen, as a failed screen. This is an indication of possible critical congenital heart disease. The hospital or birthing facility must immediately notify the newborn's physician of this failed screen.

(G) Screen all newborns admitted to a neonatal intensive care unit for critical congenital heart disease. Screening of any newborn admitted to a neonatal intensive care unit for less than 8 days must follow the protocol set out in this chapter. For any newborn in a neonatal intensive care unit longer than 7 days, the screening requirement may be met by the level of care the newborn otherwise routinely receives in the unit, which may include including prolonged pulse oximetry monitoring, chest x-rays and echocardiogram, continuous intensive monitoring and repeated physician exams.

(H) Maintain a method of verifying every newborn in its care received a screen for critical congenital heart disease. For any newborn discharged without such a screen, the hospital or birthing facility must notify the newborn's physician and parents or legal guardian, and must reschedule an appointment to complete the screen.

(I) Monitor quality indicators which must include at a minimum the number and percent of newborns with failed screens, newborns transferred without a screen, newborns referred for a pediatric echocardiogram, and the age at screening for all newborns who failed a screen.