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Texas Pulse Oximetry Project (TxPOP)

An Educational Strategy to Implement Early Detection of Critical Congenital Heart Disease Utilizing Pulse Oximetry in Apparently Healthy Newborns: A Pilot Study in Texas

Congenital heart defects are the most common birth defect, with an incidence of 9/1000 births in the United States. Some of these defects are critical, requiring early intervention and management in order to save the life of the baby. In fact, Critical Congenital Heart Disease (CCHD) is the leading cause of death in infants less than 1 year. In the United States, 4800 infants (2/1000 live births) are born annually with CCHD. Early diagnosis and timely intervention of CCHD can significantly reduce morbidity and mortality and lead to better outcomes.

Newborn screening with pulse oximetry has been shown to be useful for the detection of the seven heart defects that cause CCHD. These seven defects represent 17–31% of all congenital heart defects.
These defects are:

  • Hypoplastic Left Heart Syndrome
  • Pulmonary Atresia (with intact atrial septum)
  • Tetralogy of Fallot
  • Total Anomalous Pulmonary Venous Return
  • Transposition of the Great Arteries
  • Tricuspid Atresia
  • Truncus arteriosus

In September 2011, CCHD was added to the Recommended Uniform Screening Panel for newborns endorsed by the American Academy of Pediatrics, American Heart Association, and American College of Cardiologists. Many states have already implemented newborn CCHD screening.

Beginning in July 2012, in anticipation of legislation in Texas that would require CCHD screening for all newborns, Texas Children's Hospital joined 12 other rural and metropolitan birthing facilities in the South Texas and Houston area as part of TxPOP: the Texas Pulse Oximetry Project. This project was funded through a grant from the Department of State Health Services, and has allowed for the development of a comprehensive educational program standardized to implement early CCHD screening with pulse oximetry. The educational program developed by TxPOP includes a tool kit with a clinical algorithm, information pamphlets, videos, slide presentations, and posters. This program can be translated for use in all birthing facilities throughout Texas.

To date, over 7,000 newborns in Texas have been screened as part of the TxPOP initiative, with the expected screening of over 10,000 babies by the conclusion of the project. One apparently healthy baby with CCHD has been identified, and has already received life-saving surgery. A handful of babies with secondary diagnoses have also been identified and are receiving treatment.

In June 2013, legislation requiring CCHD screening for all newborns in Texas was signed into law. Moving forward, all birthing facilities in Texas will soon be required to implement their own protocol for CCHD screening. The educational materials developed by TxPOP are useful resources for health care providers developing strategies to provide this potentially life-saving screening for all babies.

The following files from the TXPOP Toolkit are available for health-caregivers to download to use as they implement Critical Congenital Heart Disease Screening at their institutions:

  1. Introduction Abstract
  2. Algorithm poster
  3. Algorithm laminated card
  4. Parent brochure – Positive Screen
  5. Parent brochure – General
  6. Nursing Powerpoint
  7. Nursing Powerpoint – handout
  8. MD Powerpoint
  9. MD Powerpoint – handout
  10. PreTest
  11. PostTest
  12. References
  13. Public Service Announcement Link via PPT – (must be in slide show mode)
  14. Public Service Announcement Link via PDF – (click on hyperlink)
  15. Sample of Suggested Physician Orders
  16. Sample of Suggested Nursery Policy
  17. Sample Log 1
  18. Sample Log 2