OAR 333-077-0170: Newborn Care and Screening

(1) A birthing center shall ensure that all newborns are given Vitamin K at birth in accordance with OAR 333-021-0800, the purpose of which is to protect newborns against Vitamin K deficiency bleeding. (2) A birthing center shall ensure that every newborn delivered in the birthing center is tested for metabolic diseases as required by OAR 333-024-1020. (3) A birthing center shall ensure that every newborn delivered in the birthing center receives a newborn hearing screening test or referral, and cytomegalovirus screening, as required by OAR chapter 333, division 20 and ORS 433.321. (4) The birthing center must ensure that a newborn is evaluated and treated who is at risk for gonococcal ophthalmia neonatorum in accordance with OAR 333-019-0036. (5) A birthing center must perform pulse oximetry screening on every newborn delivered at the birthing center before discharging the newborn in conformance with the following requirements: (a) The pulse oximetry screening must be performed using evidence-based guidelines such as those recommended by Strategies for Implementing Screening for Critical Congenital Heart Disease, AR Kemper et al., Pediatrics 2011;128(5): e1259–1267. (b) The birthing center must have policies and procedures based on the guidelines required by subsection (a) of this section for: (A) Determining what is considered a positive screening result; and (B) Determining what follow-up services, treatment or referrals must be provided if a newborn has a positive screening result. (c) A Federal Drug Administration (FDA) approved motion tolerant pulse oximeter must be used. (d) The pulse oximetry screening must be performed no sooner than 24 hours after birth or as close to discharge of the newborn as possible. (e) Before performing pulse oximetry screening on a newborn, birthing center staff must have received training on how to correctly operate the pulse oximeter and the policies and procedures associated with the screening. The birthing center must document this training. (f) If a newborn is admitted to hospital-based care as the result of a transfer from the birthing center before a pulse oximetry screening is performed, the hospital-based care from which the newborn is discharged to home is responsible for performing the screening. (g) The birthing center must provide the following notifications and document them in the newborn’s medical record: (A) Prior to the pulse oximetry screening, notify a client or legal representative of the newborn about the reasons for the screening and the risks and consequences of not screening. (B) Following the pulse oximetry screening, notify the health care provider responsible for the newborn and the newborn’s primary care provider of the results of the screening. (C) Following the pulse oximetry screening and prior to discharge, notify a client or legal representative of the newborn of the screening result, an explanation of its meaning and, if it is a positive screening result, provide information about the importance of timely diagnosis and intervention. (h) A client or legal representative of a newborn may decline pulse oximetry screening and, if screening is declined, the birthing center must document the declination in the newborn’s medical record. (i) Following the pulse oximetry screening, the birthing center, in accordance with the applicable standard of care, must provide any appropriate follow-up services or treatment for the newborn if necessary or provide a referral to a client or legal representative of the newborn for follow-up services or treatment if necessary. (j) The birthing center must document in the newborn’s medical record that the screening was performed, the screening result, the names of the health care providers who were notified of the screening result, and any follow-up services or treatment or referral for services or treatment. (k) No newborn may be refused screening because of the inability of a client or legal representative to pay for the screening. NOTE: The document referenced in section (5) of this rule is available upon request by contacting the Health Care Regulation and Quality Improvement section at mailbox.hclc@odhsoha.oregon.gov