Practice Alert changes with Indiana law – Congenital Heart Screening

by Stephanie Vickrey, RRT and John Murphy, MS, RRT

The following is the most recent update to the state law regarding Congenital Heart Disease (CHD) screening. The legal changes relate to pulse oximetry measurement for every newborn and relates to critical congenital heart disease screening.

The Pulse oximetry screening examination is to be performed in accordance with changes in the law as follows:

(1) not earlier than twenty-four (24); and

(2) not later than forty-eight (48) hours after birth. Preterm newborns or infants shall be given a pulse oximetry screening, including repeat screenings, at or near the time the specimen is taken as provided for in section 3(f) of this rule.

(b) Pulse oximetry screenings shall be taken from pulse oximetry readings on the right hand and one (1) foot.

(c) A passing pulse oximetry reading is an initial reading or repeat readings, which is:

(1) greater than or equal to ninety-five percent (95%) on the right hand or foot; and

(2) less than or equal to three percent (3%) variance between the right hand and foot.

(d) Except as provided in subsection,

(e) newborns who do not pass the initial pulse oximetry reading as described in subsection (c) shall have up to three (3) repeat readings performed at one (1) hour increments. If the newborn does not pass one (1) three (3) repeat readings as described in subsection (c), the newborn shall be immediately referred for a cardiology evaluation.

(e) Newborns with an initial pulse oximetry reading of less than ninety percent (90%) on right hand or foot shall be immediately referred for cardiology evaluation.

(f) Newborns referred for cardiology evaluation as required in either subsection (d) or (e) shall be given, at a minimum, diagnostic testing via echocardiogram. (Indiana State Department of Health; 410 IAC 3-3-3.5)

So what does this mean for us practically? In our area at Franciscan Health Indianapolis this means that we perform CHD screening on every baby at 24 hours regardless of gestational age or oxygen device.

Other changes include:

  • The right hand will be used exclusively; previously the wrist was acceptable.
  • We seek ≥ 95 % SpO2 in either hand or foot (both readings need not be > 95%).
  • The difference between hand and foot needs to be ≤ 3 % to pass.
  • The test must be done before 48 hours of life.
  • If you have an IV obstructing the hand, try measurement further up the arm.
  • If no right arm or feet present call for echocardiogram.
  • All other rules for CHD screening remain unchanged.

These changes are effective April 16, 2019.