Heart Defects
A federal advisory panel is now recommending that all newborns be screened for a serious heart defect before they leave the hospital and it starts with a simple oxygen test.
The test, called pulse oximetry, measures how much oxygen is in the blood using a small light sensor that's taped around a baby's wrist, the palm of a hand, or the bottom of a foot.
Several large studies have shown that pulse oximetry, or pulse ox, which costs $5 to $10 and takes about five minutes, can pick up cases of serious heart malformations early enough so that they can be corrected with surgery.
Heart malformations are the most common kind of birth defect. They affect an estimated one out of 100 births worldwide. In 25% of cases, the defects are life-threatening. But the diagnosis is sometimes missed because a baby continues to mature in the first few days after birth and nothing may look or sound wrong.
"It's very hard, in the first days of life, to make this diagnosis, even by the good doctor doing an expert physical exam," says Dr. Alan R. Fleischman, medical director of the March of Dimes in White Plains, N.Y to CBS News.
Parents bring home "a healthy, normal baby, only to have them die in their arms," says Mona Barmash, president of the Congenital Heart Information Network and mother of a son with heart defects.
Monday, a special federal advisory committee on heritable disorders unveiled a new nationwide strategy to use this method to screen newborns for congenital heart disease.
Screening Recommendations
Specifically, the panel said pulse oximetry screening should be performed in healthy babies at least 24 hours after birth but before hospital discharge.
They advised that the pulse oxygen should be tested with a probe on the right hand or foot when the baby is awake and alert.
A pulse oxygen level less than 90% in either the right hand or foot, or a level less than 95% that continued to be low after repeated measurements, would signal the need for further investigation with heart sonogram, preferably read by a pediatric cardiologist.
And that's what may hold some hospitals back from doing the test. Experts say smaller hospitals may not have the equipment or expertise to do the specialized heart sonogram.
"The implementation is difficult in rural areas. For example, if they identify a baby with a pulse ox less than 95, it requires transport. So all the docs and the administrators are saying, 'well what if it's a false positive, look at all the costs you're incurring,'" Mona Barmash, president, Congenital Heart Information Network (CHIN), tellsWebMD. But she says the test has a low false-positive rate -- less than 1%.
But even as an imperfect tool, studies suggest the test could save lives.
"If you look at data out of California," says Dr. Alex R. Kemper, associate professor of pediatrics at Duke University, "there are about 30 deaths annually due to critical congenital heart defects that are either not detected or detected late. I think that illustrates the opportunity to really improve the care that we provide."
Mid-Missouri Hospitals
While not in widespread use, four hospitals we checked with in Mid-Missouri offer the pulse ox test to all newborns before they leave the hospital.
Responding to a request via e-mail University Hospital reports they use the test on all newborns. Boone Hospital also uses it on all newborns before they are discharged.
St. Mary's Health Center says they do a pulse ox check at the time of a baby's metabolic screening, sometime after 24 hours of age. If the pulse ox reading is less than 95%, the nurses do a four quadrant blood pressures and notify the physician.
The manager of obstetrics at Capital Region Medical Center, Carol Pettigrew says, "We have checked the pulse oximetry on all newborns within an hour of birth for several years. We do a preductal check using the right hand, although according to some studies, it does not make any difference which hand you use, both are preductal which means measuring the oxygen content of the blood before it enters the R atrium to get pumped to the lungs for re-oxygenation."
The panel's plan for newborn screenings has already been endorsed by the American College of Cardiology, the American Heart Association, and the American Academy of Pediatrics. It is published in the journal Pediatrics. If Health and Human Services Secretary Kathleen Sebelius endorses the panel's recommendations, it will nudge states to add pulse oximetry screening to the routine blood and hearing tests most already do for newborns.
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