New Jersey Department of Health and Senior Services, Division of Family Health Services, Trenton, New Jersey 08625, USA.
OBJECTIVE: Congenital cardiovascular malformations (CCVMs) are relatively common with a prevalence of 5-10 per 1000 live births. Pulse oximetry screening is proposed to identify newborns with critical CCVMs which are missed by routine prenatal ultrasound and by pre-discharge physical examinations. The purpose of this study was to identify the number of infants with a delayed diagnosis of critical CCVMs potentially detectable by pre-discharge pulse oximetry screening.
PATIENTS AND METHODS: Hospital Discharge records in New Jersey from 199-2004 for infants with critical CCVMs were identified using ICD-9 codes. These records were matched to the Electronic Birth Certificate records to identify newborns who were discharged as normal newborns and were later admitted with a diagnosis of critical CCVMs. Chart review was completed on these cases to confirm a delay in diagnosis.
RESULTS: Chart reviews confirmed delayed diagnosis of critical CCVM in 47 infants out of 670,245 births. Coarctation of the Aorta was the most common delayed diagnosis. The age at final diagnosis varied from 3 days to 6.5 months.
CONCLUSIONS: Further examination of pulse oximetry as a routine newborn screening service is warranted. Implementation of pre-discharge pulse oximetry screening for newborns may improve the timely detection of asymptomatic critical CCVMs.
Source: Click here
Showing posts with label pulse oximetry. Show all posts
Showing posts with label pulse oximetry. Show all posts
Masimo SET Pulse Oximetry Increases Detection of Congenital Heart Disease
Researchers Show Multiple Defects Would Have Been Missed without Masimo SET
IRVINE, Calif., June 3, 2010 /PRNewswire via COMTEX/ -- Masimo /quotes/comstock/15*!masi/quotes/nls/masi (MASI 23.81, +0.14, +0.59%) , the inventor of Pulse CO-Oximetry(TM) and Measure-Through Motion and Low Perfusion pulse oximetry, announced today that a new clinical study published online in the German pediatric journal, Klinische Padiatrie, showed that adding Masimo SET pulse oximetry screening to the physical examination of newborns was an effective method to achieve early diagnosis of critical congenital heart disease (CHD).
CHD affects five to ten of every 1,000 newborns, resulting in 3% of all infant mortalities. Improving early detection and treatment is critical because up to 30% of all CHD-related deaths in the first year of life are due to failure to detect the condition. However, critical duct-dependent CHD is often present without abnormal auscultation (listening to sounds within the body). In total, fewer than 50% of cases are diagnosed with a clinical examination alone, so normal physical examination findings cannot exclude CHD. Multiple previous studies have proven Masimo SET pulse oximetry, along with routine clinical examination, is an effective method capable of closing this diagnostic gap to reduce the morbidity and mortality associated with CHD. In contrast, several studies using other pulse oximetry technologies have not shown effectiveness in reliably detecting CHD.
In the study, researchers from three obstetric departments in Mannheim, Germany, measured the postductal oxygen saturation of a total of 3,364 newborns between 6 and 36h of age over a year-long period. Masimo SpO2 measurements were taken via noninvasive sensors placed on the right or left foot (using the VitaGuard VG 310 with integrated Masimo SET technology). The length of the measurement procedure was 2-5min. A standardized protocol was followed: In asymptomatic newborns with SpO2 =/+ 95%, no further steps were taken. For newborns with values 90% - 94%, a check-up assessment was carried out 4-6h later and for persistent SpO2 < 90%, immediate echocardiography was ordered. Following the standardized protocol, researchers found 18 babies that qualified for echocardiographic exam and 9 were diagnosed with CHD. Five of the nine babies had normal auscultation finding in their physical exam, leading researchers to conclude: "These newborns were thus saved from potential cardiogenic shock and even sudden unexpected death." On the basis of this data, a sensitivity of 82% and a specificity of 99.9% with a positive predictive value of 50%and negative predictive value of 99.9% were calculated for the group.
The researchers concluded: "As the method is simple and reliable, has low cost, is not time consuming, creates no additional burden for the patient, and is available and usable anywhere, we would recommend that pulse oximetry screening, with its high sensitivity and specificity levels, should become established as a general screening method in the routine evaluation of the newborn."
Source: The Free Library
IRVINE, Calif., June 3, 2010 /PRNewswire via COMTEX/ -- Masimo /quotes/comstock/15*!masi/quotes/nls/masi (MASI 23.81, +0.14, +0.59%) , the inventor of Pulse CO-Oximetry(TM) and Measure-Through Motion and Low Perfusion pulse oximetry, announced today that a new clinical study published online in the German pediatric journal, Klinische Padiatrie, showed that adding Masimo SET pulse oximetry screening to the physical examination of newborns was an effective method to achieve early diagnosis of critical congenital heart disease (CHD).
CHD affects five to ten of every 1,000 newborns, resulting in 3% of all infant mortalities. Improving early detection and treatment is critical because up to 30% of all CHD-related deaths in the first year of life are due to failure to detect the condition. However, critical duct-dependent CHD is often present without abnormal auscultation (listening to sounds within the body). In total, fewer than 50% of cases are diagnosed with a clinical examination alone, so normal physical examination findings cannot exclude CHD. Multiple previous studies have proven Masimo SET pulse oximetry, along with routine clinical examination, is an effective method capable of closing this diagnostic gap to reduce the morbidity and mortality associated with CHD. In contrast, several studies using other pulse oximetry technologies have not shown effectiveness in reliably detecting CHD.
In the study, researchers from three obstetric departments in Mannheim, Germany, measured the postductal oxygen saturation of a total of 3,364 newborns between 6 and 36h of age over a year-long period. Masimo SpO2 measurements were taken via noninvasive sensors placed on the right or left foot (using the VitaGuard VG 310 with integrated Masimo SET technology). The length of the measurement procedure was 2-5min. A standardized protocol was followed: In asymptomatic newborns with SpO2 =/+ 95%, no further steps were taken. For newborns with values 90% - 94%, a check-up assessment was carried out 4-6h later and for persistent SpO2 < 90%, immediate echocardiography was ordered. Following the standardized protocol, researchers found 18 babies that qualified for echocardiographic exam and 9 were diagnosed with CHD. Five of the nine babies had normal auscultation finding in their physical exam, leading researchers to conclude: "These newborns were thus saved from potential cardiogenic shock and even sudden unexpected death." On the basis of this data, a sensitivity of 82% and a specificity of 99.9% with a positive predictive value of 50%and negative predictive value of 99.9% were calculated for the group.
The researchers concluded: "As the method is simple and reliable, has low cost, is not time consuming, creates no additional burden for the patient, and is available and usable anywhere, we would recommend that pulse oximetry screening, with its high sensitivity and specificity levels, should become established as a general screening method in the routine evaluation of the newborn."
Source: The Free Library
Should Pulse Oximetry Be Used To Screen For Congenital Heart Disease?
Ten studies (44 969 newborns, 71 severe defects) evaluating the usefulness of neonatal pulse oximetry (PO) screening in timely detection of congenital heart disease (CHD) were reviewed.
PO showed a high specificity (99.9–99.99%), and the overall rate of detection of 15 individual defects with PO was 72% (range 46–100%), exceeding that of the clinical examination 58% (9–86%). Similar results were obtained for cyanotic CHD (89% v 69%, respectively).
Without PO, discharge of apparently healthy infants with unknown CHD was 5.5 times and 4.1 times more likely in cyanotic CHD and all serious CHD, respectively.
The paper describes the technical and practical details of first day and later screening. Diagnosis is reached earliest with first day screening, but it requires more resources.
PO screening is not sensitive enough to serve as an independent screen, but along with the clinical examination it helps minimise the morbidity and mortality associated with discharge without diagnosis.
Further research is needed for precise delineation of populations that would benefit from PO screening.
Source: http://fn.bmjjournals.com/content/92/3/F219.abstract
PO showed a high specificity (99.9–99.99%), and the overall rate of detection of 15 individual defects with PO was 72% (range 46–100%), exceeding that of the clinical examination 58% (9–86%). Similar results were obtained for cyanotic CHD (89% v 69%, respectively).
Without PO, discharge of apparently healthy infants with unknown CHD was 5.5 times and 4.1 times more likely in cyanotic CHD and all serious CHD, respectively.
The paper describes the technical and practical details of first day and later screening. Diagnosis is reached earliest with first day screening, but it requires more resources.
PO screening is not sensitive enough to serve as an independent screen, but along with the clinical examination it helps minimise the morbidity and mortality associated with discharge without diagnosis.
Further research is needed for precise delineation of populations that would benefit from PO screening.
Source: http://fn.bmjjournals.com/content/92/3/F219.abstract
Routine Pulse Oximetry in the Asymptomatic Newborn
Objective: To assess the effect of routine measurement of postductal oxygen saturation as an adjunct to routine clinical examination in the asymptomatic newborn.
Design and setting: Prospective study in a district general hospital.
Patients: All 6166 infants inborn between 1 April 1999 and 31 March 2001.
Intervention: Oxygen saturation was measured over two minutes, after the age of 2 hours and before discharge, in one foot of all babies not admitted directly to the neonatal unit. Babies with fractional (as opposed to functional) oxygen saturation (SaO2) below 95% were examined by the midwife. If this examination was abnormal or if normal but further measurements were below 95%, an echocardiogram was performed. All babies with cardiac malformations diagnosed by 1 year of age were identified from databases maintained at the regional cardiology referral unit and the regional congenital malformation survey.
Results: Measurements were made in 98% of eligible babies. A fractional SaO2 less than 95% was found in 5% but persisted in only 1%. Structural cardiac malformations were found in 50 (8.1/1000), 26 of whom had isolated ventricular septal defects. Of the remaining 24 with other cardiac malformations, attention was first drawn to six by low SaO2, and four more, first noticed for other reasons, also had low SaO2. Low SaO2 also first drew attention to 13 other babies ill for other reasons.
Conclusion: Newborn babies with important cardiac malformations are often asymptomatic initially and the yield from clinical examination is poor. Measuring postductal saturation routinely in newborn babies before discharge is easy and can alert staff to ill babies.
Source: http://fn.bmjjournals.com/content/87/2/F83.abstract
Design and setting: Prospective study in a district general hospital.
Patients: All 6166 infants inborn between 1 April 1999 and 31 March 2001.
Intervention: Oxygen saturation was measured over two minutes, after the age of 2 hours and before discharge, in one foot of all babies not admitted directly to the neonatal unit. Babies with fractional (as opposed to functional) oxygen saturation (SaO2) below 95% were examined by the midwife. If this examination was abnormal or if normal but further measurements were below 95%, an echocardiogram was performed. All babies with cardiac malformations diagnosed by 1 year of age were identified from databases maintained at the regional cardiology referral unit and the regional congenital malformation survey.
Results: Measurements were made in 98% of eligible babies. A fractional SaO2 less than 95% was found in 5% but persisted in only 1%. Structural cardiac malformations were found in 50 (8.1/1000), 26 of whom had isolated ventricular septal defects. Of the remaining 24 with other cardiac malformations, attention was first drawn to six by low SaO2, and four more, first noticed for other reasons, also had low SaO2. Low SaO2 also first drew attention to 13 other babies ill for other reasons.
Conclusion: Newborn babies with important cardiac malformations are often asymptomatic initially and the yield from clinical examination is poor. Measuring postductal saturation routinely in newborn babies before discharge is easy and can alert staff to ill babies.
Source: http://fn.bmjjournals.com/content/87/2/F83.abstract
Pulse Oximetry - A Systematic Review
Objective: To evaluate the accuracy of pulse oximetry as a screening tool for congenital heart disease in asymptomatic newborns.
Design, data sources, and methods: Systematic review of relevant studies identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results to construct 2x 2 tables with congenital heart disease as the reference standard. We used a random- effects bivariate model to meta-analyse estimates of sensitivity and specificity. Logit pairs of sensitivity and specificity of each study were analysed in a single model, accounting for their correlation due to differences in threshold between studies.
Results: We extracted 8 studies with a total of 35,960 newborns. Pulse oximetry was performed on asymptomatic newborns in all studies, with three studies excluding newborns with an antenatal diagnosis of congenital heart disease. The studies measured either functional or fractional oxygen saturation by pulse oximetry with oxygen saturation below 95% considered as the cut off level in most studies. Based on 8 studies, the summary estimates of sensitivity and specificity were 63% (95% CI, 39% to 83%) and 99.8% (95% CI, 99% to 100%) respectively, yielding a false positive rate of 0.2% (95% CI, 0% to 1%).
Conclusion: Pulse oximetry has been shown to be highly specific tool with very low false positive rates to detect congenital heart disease. Further large well conducted prospective studies are needed to assess its sensitivity with higher precision.
Source: http://fn.bmj.com/content/early/2007/03/07/adc.2006.107656.short
Design, data sources, and methods: Systematic review of relevant studies identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results to construct 2x 2 tables with congenital heart disease as the reference standard. We used a random- effects bivariate model to meta-analyse estimates of sensitivity and specificity. Logit pairs of sensitivity and specificity of each study were analysed in a single model, accounting for their correlation due to differences in threshold between studies.
Results: We extracted 8 studies with a total of 35,960 newborns. Pulse oximetry was performed on asymptomatic newborns in all studies, with three studies excluding newborns with an antenatal diagnosis of congenital heart disease. The studies measured either functional or fractional oxygen saturation by pulse oximetry with oxygen saturation below 95% considered as the cut off level in most studies. Based on 8 studies, the summary estimates of sensitivity and specificity were 63% (95% CI, 39% to 83%) and 99.8% (95% CI, 99% to 100%) respectively, yielding a false positive rate of 0.2% (95% CI, 0% to 1%).
Conclusion: Pulse oximetry has been shown to be highly specific tool with very low false positive rates to detect congenital heart disease. Further large well conducted prospective studies are needed to assess its sensitivity with higher precision.
Source: http://fn.bmj.com/content/early/2007/03/07/adc.2006.107656.short
Your Pulse Oximetry Questions Answered Here!
What is Newborn Screening with Pulse Oximetry?
Pulse oximetry monitoring uses a light source and sensor to measure oxygen in the blood. A soft, wrapped sensor is wrapped around the baby’s foot. Light passing through the foot measures the amount of oxygen in the blood. The test is quick (3-5 minutes) and painless. Pulse oximetry monitoring should detect most heart defects.
Why is it important to check babies for heart defects?
If undetected, some congenital heart defects can cause serious or even life-threatening problems. Early detection and early treatment lead to better outcomes.
Why check the blood oxygen level with pulse oximetry?
A low oxygen saturation level may indicate the presence of a heart defect.
What are the benefits of the screening?
Babies are less likely to be sent home with unidentified heart problems – some of which can cause acute, emergency situations or even death. If identified in the first 24-48 hours of life, medical teams are available for diagnosis and treatment of CHDs. Critical congenital heart defects, requiring immediate treatment or repair, can be performed before discharge from the hospital.
Will screening find all types of heart defects?
No current screening tool exists to detect CHDs 100 percent of the time. Pulse oximetry screening should detect most heart defects (those associated with a low blood oxygen level). However, some heart detects may not be found on screening (those not associated with a low blood oxygen level).
What will happen if a baby has a low blood oxygen level?
The pulse oximetry test will be done again. If the level is still lower than expected, then an echocardiogram (sonogram of the heart) will be done. A pediatric cardiologist will ‘read’ the echocardiogram to check for the presence of a heart defect. If a CHD is found, the pediatric cardiologist will start collaborating on those findings and working on treatment options. Most heart defects can be corrected or improved with surgery, procedures and/or medications.
What are the other signs and symptoms of heart defects parents can watch for?
Pulse oximetry monitoring uses a light source and sensor to measure oxygen in the blood. A soft, wrapped sensor is wrapped around the baby’s foot. Light passing through the foot measures the amount of oxygen in the blood. The test is quick (3-5 minutes) and painless. Pulse oximetry monitoring should detect most heart defects.
Why is it important to check babies for heart defects?
If undetected, some congenital heart defects can cause serious or even life-threatening problems. Early detection and early treatment lead to better outcomes.
Why check the blood oxygen level with pulse oximetry?
A low oxygen saturation level may indicate the presence of a heart defect.
What are the benefits of the screening?
Babies are less likely to be sent home with unidentified heart problems – some of which can cause acute, emergency situations or even death. If identified in the first 24-48 hours of life, medical teams are available for diagnosis and treatment of CHDs. Critical congenital heart defects, requiring immediate treatment or repair, can be performed before discharge from the hospital.
Will screening find all types of heart defects?
No current screening tool exists to detect CHDs 100 percent of the time. Pulse oximetry screening should detect most heart defects (those associated with a low blood oxygen level). However, some heart detects may not be found on screening (those not associated with a low blood oxygen level).
What will happen if a baby has a low blood oxygen level?
The pulse oximetry test will be done again. If the level is still lower than expected, then an echocardiogram (sonogram of the heart) will be done. A pediatric cardiologist will ‘read’ the echocardiogram to check for the presence of a heart defect. If a CHD is found, the pediatric cardiologist will start collaborating on those findings and working on treatment options. Most heart defects can be corrected or improved with surgery, procedures and/or medications.
What are the other signs and symptoms of heart defects parents can watch for?
- Baby tires easily during feeding (falls asleep before feeding finishes)
- Sweating around the head, especially during feeding
- Fast breathing when at rest or sleeping
- Pale or bluish skin color
- Poor weight gain
- Sleeps a lot, not playful or curious for any length of time
- Puffy face, hands and/or feet
- Often irritable, difficult to console
Congenital Heart Defects (CHDs) are defects that are present at birth and affect the structure or function of the heart or vessels.
- Heart defects are the most common birth defect.
- CHDs occur in approximately one of every 100 births.
- About 40,000 babies with CHD are born in the US each year.
- Although some babies will be diagnosed before birth or at birth, sometimes the diagnosis is not made until days, weeks, months or even years later.
Source: 1in100.org
Pulse Oximetry - A Swedish Prospective Screening Study
Objective - To evaluate the use of pulse oximetry to screen for early detection of life threatening congenital heart disease. Design - Prospective screening study with a new generation pulse oximeter before discharge from well baby nurseries in West Götaland. Cohort study comparing the detection rate of duct dependent circulation in West Götaland with that in other regions not using pulse oximetry screening. Deaths at home with undetected duct dependent circulation were included.
Setting - All 5 maternity units in West Götaland and the supraregional referral centre for neonatal cardiac surgery.
Participants - 39 821 screened babies born between 1 July 2004 and 31 March 2007. Total duct dependent circulation cohorts: West Götaland n=60, other referring regions n=100.
Main outcome measures - Sensitivity, specificity, positive and negative predictive values, and likelihood ratio for pulse oximetry screening and for neonatal physical examination alone.
Results - In West Götaland 29 babies in well baby nurseries had duct dependent circulation undetected before neonatal discharge examination. In 13 cases, pulse oximetry showed oxygen saturations 90%, and (in accordance with protocol) clinical staff were immediately told of the results. Of the remaining 16 cases, physical examination alone detected 10 (63%). Combining physical examination with pulse oximetry screening had a sensitivity of 24/29 (82.8% (95% CI 64.2% to 95.2%)) and detected 100% of the babies with duct dependent lung circulation. Five cases were missed (all with aortic arch obstruction). False positive rate with pulse oximetry was substantially lower than that with physical examination alone (69/39 821 (0.17%) v 729/38 413 (1.90%), P<0.0001), p="0.0025," p="0.0010)," p="0.0025," p="0.0054).">Conclusion - Introducing pulse oximetry screening before discharge improved total detection rate of duct dependent circulation to 92%. Such screening seems cost neutral in the short term, but the probable prevention of neurological morbidity and reduced need for preoperative neonatal intensive care suggest that such screening will be cost effective long term.
False positive results with pulse oximetry The "false" positive rate for oximetry screening was 69/39 821 (0.17%) (see fig). Table 3 shows that 45% (31/69) of the "false positive" babies detected by pulse oximetry had other significant heart malformation, lung problem, or infection. In terms of benefit derived by early detection of babies with pathology other than duct dependent heart disease, table 3 suggests that 12% required cardiac surgery, 29% required further follow-up, and that neonatal intensive care was required in 5 days for 26%.
The above are excerpts from the full report. To read the full report, click here.
Setting - All 5 maternity units in West Götaland and the supraregional referral centre for neonatal cardiac surgery.
Participants - 39 821 screened babies born between 1 July 2004 and 31 March 2007. Total duct dependent circulation cohorts: West Götaland n=60, other referring regions n=100.
Main outcome measures - Sensitivity, specificity, positive and negative predictive values, and likelihood ratio for pulse oximetry screening and for neonatal physical examination alone.
Results - In West Götaland 29 babies in well baby nurseries had duct dependent circulation undetected before neonatal discharge examination. In 13 cases, pulse oximetry showed oxygen saturations 90%, and (in accordance with protocol) clinical staff were immediately told of the results. Of the remaining 16 cases, physical examination alone detected 10 (63%). Combining physical examination with pulse oximetry screening had a sensitivity of 24/29 (82.8% (95% CI 64.2% to 95.2%)) and detected 100% of the babies with duct dependent lung circulation. Five cases were missed (all with aortic arch obstruction). False positive rate with pulse oximetry was substantially lower than that with physical examination alone (69/39 821 (0.17%) v 729/38 413 (1.90%), P<0.0001), p="0.0025," p="0.0010)," p="0.0025," p="0.0054).">Conclusion - Introducing pulse oximetry screening before discharge improved total detection rate of duct dependent circulation to 92%. Such screening seems cost neutral in the short term, but the probable prevention of neurological morbidity and reduced need for preoperative neonatal intensive care suggest that such screening will be cost effective long term.
False positive results with pulse oximetry The "false" positive rate for oximetry screening was 69/39 821 (0.17%) (see fig). Table 3 shows that 45% (31/69) of the "false positive" babies detected by pulse oximetry had other significant heart malformation, lung problem, or infection. In terms of benefit derived by early detection of babies with pathology other than duct dependent heart disease, table 3 suggests that 12% required cardiac surgery, 29% required further follow-up, and that neonatal intensive care was required in 5 days for 26%.
The above are excerpts from the full report. To read the full report, click here.
Pulse Oximetry - A Scientific Statement From the AHA and AAP
Background— The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD).
Methods and Results— A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours.
Conclusions— Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.
Currently, children with CCHD are diagnosed by a variety of mechanisms. Neonates with CCHD may be diagnosed in the newborn nursery on the basis of physical examination findings, such as heart murmurs, tachypnea, or overt cyanosis. These findings are not always evident before hospital discharge, which may occur before 48 hours of life. A recent study from the United Kingdom suggested that 25% of infants with CCHD were not diagnosed with heart disease until after discharge from the newborn nursery. The median age of diagnosis in these cases was 6 weeks. A recent publication from the United States suggested that delayed or missed diagnosis occurs in 7 per 100 000 livebirths. However, because these data are derived from a birth defect surveillance program with passive and thus incomplete case ascertainment, this calculation most likely represents a minimum estimate.
Newborns with CCHD are susceptible to profound, sudden worsening in clinical status in the first days and weeks of life. These acute physiological changes correspond to changes in pulmonary vascular resistance and closure of the ductus arteriosus. In neonates with CCHD, the ductus arteriosus is often essential for maintaining either pulmonary or systemic blood flow. These CCHD defects are considered ductus arteriosus–dependent lesions. The newborn hospitalization provides a critical window for caregivers to identify CCHD lesions in order to avoid hemodynamic embarrassment. The timing of constriction or closure of the ductus arteriosus also explains why children with CCHD may be particularly vulnerable to cardiovascular collapse soon after discharge from the newborn nursery.
Children with CCHD are identified in a variety of ways. Since the late 1980s, prenatal ultrasound has been used to screen for congenital anomalies. An anatomic ultrasound is typically performed at 18 to 20 weeks’ gestation. During this process many, but not all, cases of CCHD can be identified by a methodical scan. When CCHD is identified by this approach, the patient is often referred to a pediatric cardiologist for confirmatory imaging and counseling. With knowledge that the fetus has CCHD, the newborn can be delivered in a hospital capable of providing intensive care, including prostaglandin, as well as mechanical ventilation. The newborn can be stabilized and transferred to a congenital heart center.
Prenatal ultrasound, performed by those with specific training in congenital heart disease, can identify a variety of CCHD lesions; however, numerous studies have reported that even when fetal ultrasound is routinely performed during pregnancy, fewer than 50% of cases of CCHD are identified. Most of the published literature comes from European countries, which tend to have more centralized healthcare systems and uniform practices vis-à-vis prenatal ultrasound. As such, these systems may represent the best-case scenario for population prenatal ultrasound screening. In the United States, many congenital surgery referral centers have reported prenatal detection rates >50% for functional single-ventricle lesions, although the detection rate is generally <30%>24 hours after birth would appear to be the most reasonable strategy. This screening strategy assumes that the majority of newborns will not be discharged on the first day of life. With early discharge at less than 24 hours of age, many infants would not be screened.
The above are excerpts from the full report. To read the full report, click here.
Methods and Results— A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours.
Conclusions— Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.
Currently, children with CCHD are diagnosed by a variety of mechanisms. Neonates with CCHD may be diagnosed in the newborn nursery on the basis of physical examination findings, such as heart murmurs, tachypnea, or overt cyanosis. These findings are not always evident before hospital discharge, which may occur before 48 hours of life. A recent study from the United Kingdom suggested that 25% of infants with CCHD were not diagnosed with heart disease until after discharge from the newborn nursery. The median age of diagnosis in these cases was 6 weeks. A recent publication from the United States suggested that delayed or missed diagnosis occurs in 7 per 100 000 livebirths. However, because these data are derived from a birth defect surveillance program with passive and thus incomplete case ascertainment, this calculation most likely represents a minimum estimate.
Newborns with CCHD are susceptible to profound, sudden worsening in clinical status in the first days and weeks of life. These acute physiological changes correspond to changes in pulmonary vascular resistance and closure of the ductus arteriosus. In neonates with CCHD, the ductus arteriosus is often essential for maintaining either pulmonary or systemic blood flow. These CCHD defects are considered ductus arteriosus–dependent lesions. The newborn hospitalization provides a critical window for caregivers to identify CCHD lesions in order to avoid hemodynamic embarrassment. The timing of constriction or closure of the ductus arteriosus also explains why children with CCHD may be particularly vulnerable to cardiovascular collapse soon after discharge from the newborn nursery.
Children with CCHD are identified in a variety of ways. Since the late 1980s, prenatal ultrasound has been used to screen for congenital anomalies. An anatomic ultrasound is typically performed at 18 to 20 weeks’ gestation. During this process many, but not all, cases of CCHD can be identified by a methodical scan. When CCHD is identified by this approach, the patient is often referred to a pediatric cardiologist for confirmatory imaging and counseling. With knowledge that the fetus has CCHD, the newborn can be delivered in a hospital capable of providing intensive care, including prostaglandin, as well as mechanical ventilation. The newborn can be stabilized and transferred to a congenital heart center.
Prenatal ultrasound, performed by those with specific training in congenital heart disease, can identify a variety of CCHD lesions; however, numerous studies have reported that even when fetal ultrasound is routinely performed during pregnancy, fewer than 50% of cases of CCHD are identified. Most of the published literature comes from European countries, which tend to have more centralized healthcare systems and uniform practices vis-à-vis prenatal ultrasound. As such, these systems may represent the best-case scenario for population prenatal ultrasound screening. In the United States, many congenital surgery referral centers have reported prenatal detection rates >50% for functional single-ventricle lesions, although the detection rate is generally <30%>24 hours after birth would appear to be the most reasonable strategy. This screening strategy assumes that the majority of newborns will not be discharged on the first day of life. With early discharge at less than 24 hours of age, many infants would not be screened.
The above are excerpts from the full report. To read the full report, click here.
CHD Awareness Day News Interview
Since August 2009, I've been writing all the news stations trying to get them to help me raise CHD Awareness. I finally heard back from our local Fox news station. We decided to do a CHD Awareness interview on CHD Awareness Day!
The interview was very in-depth and I talked a ton about congenital heart defects. We also talked about my efforts in Missouri with Chloe's Law. Unfortunately, after the editing process, only the parts about Chloe's law remained. I was slightly disappointed as I had hoped more info about CHD would have made the cut, but at least one statistic and some CHD symptoms were included.
The interview aired at 9pm and 10pm on CHD Awareness Day (2/14/10). It also re-ran again most of the following morning. I'm very glad it was aired again at different times, hopefully reaching as many people as possible.
Here's the video:
The interview was very in-depth and I talked a ton about congenital heart defects. We also talked about my efforts in Missouri with Chloe's Law. Unfortunately, after the editing process, only the parts about Chloe's law remained. I was slightly disappointed as I had hoped more info about CHD would have made the cut, but at least one statistic and some CHD symptoms were included.
The interview aired at 9pm and 10pm on CHD Awareness Day (2/14/10). It also re-ran again most of the following morning. I'm very glad it was aired again at different times, hopefully reaching as many people as possible.
Here's the video:
Parenting Starts At Conception: CHD Awareness To Help You Be An Advocate For Your Unborn Child
What is congenital heart disease (CHD)? Congenital heart disease (CHD) is the most common birth defect. Infants with CHD have abnormal structure to their heart which creates abnormal blood flow patterns. Approximately eight of every 1,000 infants born have a form of CHD. Some forms of CHD cause no or very few problems in the health, growth, and development of the baby. However, critical CHD can bring a significant risk of morbidity and mortality if not diagnosed soon after birth. Failing to detect critical CHD while in the newborn nursery may lead to critical events such as cardiogenic shock or death. Survivors who present late are at greater risk for neurologic injury and subsequent developmental delay.
What is pulse oximetry? Pulse oximetry (ox-eh-mah-tree), or “pulse ox,” is a simple, non-invasive and painless test that is used to measure the percent oxygen saturation of hemoglobin in the arterial blood and the pulse rate. Pulse ox was invented in the 1970’s and is now widely used and accepted in clinical care; it is often thought to be a basic vital sign.
How is pulse ox performed? The pulse ox is placed by a sticky strip, like a band-aid™, with a small red light, or “probe,” on the baby’s foot. The probe is attached to a wire, which is attached to a special monitor that shows the pulse ox reading. The pulse ox test takes just a few minutes to perform when a baby is still, quiet, and warm. If a baby is crying, squirming, or cold it may take longer or not be possible. You can help comfort your baby and keep him or her warm, calm, and quiet while the test is being performed.
Why is pulse oximetry used to screen for CHD? Pulse ox is used to measure how much oxygen is in the blood. Pulse ox is a routinely used test that can be used to monitor an baby's oxygen level during a procedure or treatment. It can also be helpful in determining if an baby’s heart and lungs are healthy. Pulse ox can also help to identify babies with low levels of oxygen in their blood that may have serious heart problems. A doctor or nurse practitioner may ask for more testing such as an ultrasound of the heart, or echocardiogram (or “echo”) when a low pulse ox reading is identified. The echo will screen for a serious problem in the structure of the heart or the blood flow through the heart. Pulse ox can identify a baby with serious CHD before he or she leaves the newborn nursery.
Who should be screened? All babies in the newborn nursery who are not already thought to have CHD should be screened. When will the pulse ox test be performed? The pulse ox test will be done after the baby is born when he or she is older than 24 hours. The pulse ox test will be done if the baby isn’t already thought to have a problem with the heart or lungs.
Can the pulse ox test hurt my child? The pulse ox test is non-invasive and painless. It usually does not hurt the baby. Where should pulse ox screening be performed? Pulse ox screening should be performed while the infant is in the newborn nursery, before he or she goes home.
What is a normal reading? A pulse ox reading of 95 to 100 percent is normal in healthy babies. Babies with heart or lung problems may have lower readings. A low pulse oximetry reading can be normal in newborns whose lungs and heart are adjusting after birth. If your baby has a problem with his or her heart or lungs, your doctor or nurse will tell you what constitutes a normal pulse ox range for your child. It is possible that your baby’s doctor will order additional tests.
Can a baby with serious CHD have a normal pulse ox reading? It is possible that the pulse ox test will not detect all forms of problems in the baby's heart. Your baby should continue to have normal visits with his or her primary care doctor. If a problem with the heart is suspected, your primary care doctor will advise you.
What if I have questions or do not want to have my baby screened for serious heart problems? If you have questions about pulse ox or CHD, you should ask the doctor or nurse practitioner that is providing your prenatal care or the doctor or nurse caring for your baby after he or she is born. If you do not want your baby screened for serious heart problems you should tell your doctor or nurse when you are in the hospital to deliver your baby. Source: Childrens National Medical Center, Washington DC
What is pulse oximetry? Pulse oximetry (ox-eh-mah-tree), or “pulse ox,” is a simple, non-invasive and painless test that is used to measure the percent oxygen saturation of hemoglobin in the arterial blood and the pulse rate. Pulse ox was invented in the 1970’s and is now widely used and accepted in clinical care; it is often thought to be a basic vital sign.
How is pulse ox performed? The pulse ox is placed by a sticky strip, like a band-aid™, with a small red light, or “probe,” on the baby’s foot. The probe is attached to a wire, which is attached to a special monitor that shows the pulse ox reading. The pulse ox test takes just a few minutes to perform when a baby is still, quiet, and warm. If a baby is crying, squirming, or cold it may take longer or not be possible. You can help comfort your baby and keep him or her warm, calm, and quiet while the test is being performed.
Why is pulse oximetry used to screen for CHD? Pulse ox is used to measure how much oxygen is in the blood. Pulse ox is a routinely used test that can be used to monitor an baby's oxygen level during a procedure or treatment. It can also be helpful in determining if an baby’s heart and lungs are healthy. Pulse ox can also help to identify babies with low levels of oxygen in their blood that may have serious heart problems. A doctor or nurse practitioner may ask for more testing such as an ultrasound of the heart, or echocardiogram (or “echo”) when a low pulse ox reading is identified. The echo will screen for a serious problem in the structure of the heart or the blood flow through the heart. Pulse ox can identify a baby with serious CHD before he or she leaves the newborn nursery.
Who should be screened? All babies in the newborn nursery who are not already thought to have CHD should be screened. When will the pulse ox test be performed? The pulse ox test will be done after the baby is born when he or she is older than 24 hours. The pulse ox test will be done if the baby isn’t already thought to have a problem with the heart or lungs.
Can the pulse ox test hurt my child? The pulse ox test is non-invasive and painless. It usually does not hurt the baby. Where should pulse ox screening be performed? Pulse ox screening should be performed while the infant is in the newborn nursery, before he or she goes home.
What is a normal reading? A pulse ox reading of 95 to 100 percent is normal in healthy babies. Babies with heart or lung problems may have lower readings. A low pulse oximetry reading can be normal in newborns whose lungs and heart are adjusting after birth. If your baby has a problem with his or her heart or lungs, your doctor or nurse will tell you what constitutes a normal pulse ox range for your child. It is possible that your baby’s doctor will order additional tests.
Can a baby with serious CHD have a normal pulse ox reading? It is possible that the pulse ox test will not detect all forms of problems in the baby's heart. Your baby should continue to have normal visits with his or her primary care doctor. If a problem with the heart is suspected, your primary care doctor will advise you.
What if I have questions or do not want to have my baby screened for serious heart problems? If you have questions about pulse ox or CHD, you should ask the doctor or nurse practitioner that is providing your prenatal care or the doctor or nurse caring for your baby after he or she is born. If you do not want your baby screened for serious heart problems you should tell your doctor or nurse when you are in the hospital to deliver your baby. Source: Childrens National Medical Center, Washington DC
A Version of Chloe's Law in Nebraska!
All Nebraska newborns would be screened for congenital heart defects using pulse oximetry under a bill heard by the Health and Human Services Committee Feb. 10.
Tekamah Sen. Kent Rogert, sponsor of LB1067, said congenital heart defects occur in approximately 1 in 110 births and are the leading cause of newborn and infant death.
Studies show that half of serious congenital heart defects are missed during routine examinations after birth, he said, and that pulse oximetry can detect three-fourths of critical defects.
“Early detection is key,” Rogert said. “We can save lives.”
Marci Smith, whose daughter was born with a serious congenital heart defect, testified in support of the bill. She said the defect was not detected during pregnancy or during her daughter’s initial health assessment.
“Even the most severe heart defects can go undetected,” she said, adding that pulse oximetry helped in her daughter’s diagnosis.
“Her early intervention may have been the pivotal moment that saved her life,” Smith said. “The screening is not invasive and it gives an immediate response.”
Don Wesely, testifying on behalf of the Nebraska Nurses Association, also supported the bill.
Physical exams often fail to detect congenital heart defects, he said, and the nurses association supports the bill’s attempt to improve detection rates.
“This won’t catch every case, but it will catch some,” Wesely said. “It will save lives.”
David Buntain of the Nebraska Medical Association testified in opposition, saying decisions about which medical tests to perform should be left to medical professionals.
“The Legislature should not be put in the position of legislating standards of care,” he said.
The committee took no immediate action on LB1067.
Source: Unicameral Update
Tekamah Sen. Kent Rogert, sponsor of LB1067, said congenital heart defects occur in approximately 1 in 110 births and are the leading cause of newborn and infant death.
Studies show that half of serious congenital heart defects are missed during routine examinations after birth, he said, and that pulse oximetry can detect three-fourths of critical defects.
“Early detection is key,” Rogert said. “We can save lives.”
Marci Smith, whose daughter was born with a serious congenital heart defect, testified in support of the bill. She said the defect was not detected during pregnancy or during her daughter’s initial health assessment.
“Even the most severe heart defects can go undetected,” she said, adding that pulse oximetry helped in her daughter’s diagnosis.
“Her early intervention may have been the pivotal moment that saved her life,” Smith said. “The screening is not invasive and it gives an immediate response.”
Don Wesely, testifying on behalf of the Nebraska Nurses Association, also supported the bill.
Physical exams often fail to detect congenital heart defects, he said, and the nurses association supports the bill’s attempt to improve detection rates.
“This won’t catch every case, but it will catch some,” Wesely said. “It will save lives.”
David Buntain of the Nebraska Medical Association testified in opposition, saying decisions about which medical tests to perform should be left to medical professionals.
“The Legislature should not be put in the position of legislating standards of care,” he said.
The committee took no immediate action on LB1067.
Source: Unicameral Update
If You Live in Missouri, Please Help Pass Chloe's Law
For the past six months, I have been working on "Chloe's Law". It is a statewide bill for Missouri to make Pulse Oximetry Screening mandatory on all newborns before leaving the health care facility. This screening is a simple, fast, painless and inexpensive test to measure the oxygen level in the blood. This test can also help detect a Congenital Heart Defect in some newborns.
A baby is born with a Congenital Heart Defect (CHD) every 15 minutes, and a majority of these baby's CHDs go undetected during pregnancy. We don't want to send these babies home too soon! This test saves lives! My daughter Chloe is proof.
I have the support of my local Missouri House Representative Luke Scavuzzo. "Chloe's Law" has been filed and assigned a bill number. The next step is to get other Missouri House Representatives to support it. One way to do that is to have other Missourians contact the House Representative in their district and ask them to support this bill.
I would really appreciate any help I can get! All you have to do is follow the easy steps below!
A baby is born with a Congenital Heart Defect (CHD) every 15 minutes, and a majority of these baby's CHDs go undetected during pregnancy. We don't want to send these babies home too soon! This test saves lives! My daughter Chloe is proof.
I have the support of my local Missouri House Representative Luke Scavuzzo. "Chloe's Law" has been filed and assigned a bill number. The next step is to get other Missouri House Representatives to support it. One way to do that is to have other Missourians contact the House Representative in their district and ask them to support this bill.
I would really appreciate any help I can get! All you have to do is follow the easy steps below!
- You will need your 9 digit zip code to look up your local House Representative. If you do not know it, click here to look it up.
- To find the email and/or mailing address of the House Representative for your district, click here and enter your 9 digit zip code.
- Send an email or letter to your local House Representative, asking him/her to support Chloe's Law - House Bill Number 1604.
- At the bottom of your email or letter, please include your full name and address, especially the 9 digit zip code, so the House Representative knows that you live in his/her district.
If you need ideas on what to say in your email or letter, here is a sample of what my friend wrote:
Dear Representative XXXXXX,
I have a loved one who was born with a Congenital Heart Defect (CHD) in 2008. Nine hours after Chloe was born, her parents felt there was something wrong with her. They strongly urged the nurses to do more testing on Chloe, even though she scored high on the APGAR tests and was not showing any "classic" signs of illness. A few hours later, the nurses finally did a Pulse Oximetry Screening and discovered that Chloe was born with a rare Congenital Heart Defect. The Pulse Oximetry Screening saved Chloe's life.
Congenital Heart Defects (CHD) are America's #1 birth defect. Every 15 minutes, a baby is born with a CHD (American Heart Association). The majority of these baby's CHDs go undetected during pregnancy (like Chloe's). Some babies born with a heart defect need oxygen, medication and surgery immediately, so detecting the heart defect before sending them home can save the baby's life.
Please don't send a baby home from the hospital too soon. Please support House Bill #1604, Chloe's Law, which expands the newborn screening requirements in section 191.331 to include Pulse Oximetry Screening prior to discharge of the newborn from the health care facility.
Thank you for being a voice for our community and supporting Chloe's Law.
FULL NAME
FULL ADDRESS
FULL CITY AND STATE
12345-6789
Another Positive Study on the Benefits of Pulse Oximetry Screening at Birth
Routine screening of newborn babies for a life-threatening heart problem can save lives, a Swedish study has found.
Researchers found checking blood oxygen levels increased detection of a congenital heart defect which affects up to two in a thousand babies.
The British Medical Journal online study says just under a third currently leave hospital undiagnosed, leading to added complications and more deaths.
UK experts are investigating if screening should be introduced.
In affected babies, a blood vessel called the ductus arteriosus - which bypasses the baby's non-functioning lungs when in the uterus and normally closes off soon after birth - remains partly open.
Experts are seeking better ways of detecting such defects as soon as possible after birth.
Babies can display symptoms such as a heart murmur, look "blue", be breathless or be unable to feed.
But others do not show any signs of illness, and so defects can be missed until the baby's condition deteriorates because their heart cannot cope.
And the researchers suggest that as the time mothers stay in hospital with their newborn babies is reduced, the number leaving hospital with the duct malformation is likely to increase.
Better accuracy
The pulse oximetry screening technique uses light sensors on the hand and foot to measure the concentration of oxygen in the blood. The non-invasive takes just a few minutes to complete and has a low rate of false-positive results.
A low concentration of oxygen can be a sign there is a heart problem and that further tests are needed.
The researchers screened all 39,800 babies born in the West Gotaland region of Sweden between July 2004 and March 2007 using pulse oximetry before a physical examination was carried out.
Sixty babies were found to have the disorder.
The accuracy of their results was compared with other Swedish regions where only physical checks were used, where 100 children were diagnosed.
The combination of pulse oximetry screening and physical checks detected 92% of duct-dependent heart disease cases, compared with 72% picked up through physical checks alone.
No babies died in West Gotaland from undiagnosed heart disease, while there were five deaths in the other regions.
Writing in the BMJ study, the researchers led by Professor Ingegerd Ostman-Smith of Gothenburg University, said: "Such screening seems cost neutral in the short term, but the probable prevention of neurological morbidity and reduced need for preoperative neonatal intensive care suggest that such screening will be cost effective long term."
In an editorial in the same journal, Professor Keith Barrington from Canada's University of Montreal said the study suggested pulse oximetry was a low risk and low cost strategy for improving the detection of critical congenital heart disease.
He added: "Serious consideration should be given to its introduction wherever neonatal cardiac surgery is available."
Cathy Ross, of the British Heart Foundation said: "At the moment there are only a limited number of hospitals that would be able to carry out the necessary specialised echocardiograms required to confirm a diagnosis.
"Careful consideration will be needed as to how these practical and logistical problems can be overcome before this is widely offered in the NHS."
Source: BBC News, 01-16-10
Researchers found checking blood oxygen levels increased detection of a congenital heart defect which affects up to two in a thousand babies.
The British Medical Journal online study says just under a third currently leave hospital undiagnosed, leading to added complications and more deaths.
UK experts are investigating if screening should be introduced.
In affected babies, a blood vessel called the ductus arteriosus - which bypasses the baby's non-functioning lungs when in the uterus and normally closes off soon after birth - remains partly open.
Experts are seeking better ways of detecting such defects as soon as possible after birth.
Babies can display symptoms such as a heart murmur, look "blue", be breathless or be unable to feed.
But others do not show any signs of illness, and so defects can be missed until the baby's condition deteriorates because their heart cannot cope.
And the researchers suggest that as the time mothers stay in hospital with their newborn babies is reduced, the number leaving hospital with the duct malformation is likely to increase.
Better accuracy
The pulse oximetry screening technique uses light sensors on the hand and foot to measure the concentration of oxygen in the blood. The non-invasive takes just a few minutes to complete and has a low rate of false-positive results.
A low concentration of oxygen can be a sign there is a heart problem and that further tests are needed.
The researchers screened all 39,800 babies born in the West Gotaland region of Sweden between July 2004 and March 2007 using pulse oximetry before a physical examination was carried out.
Sixty babies were found to have the disorder.
The accuracy of their results was compared with other Swedish regions where only physical checks were used, where 100 children were diagnosed.
The combination of pulse oximetry screening and physical checks detected 92% of duct-dependent heart disease cases, compared with 72% picked up through physical checks alone.
No babies died in West Gotaland from undiagnosed heart disease, while there were five deaths in the other regions.
Writing in the BMJ study, the researchers led by Professor Ingegerd Ostman-Smith of Gothenburg University, said: "Such screening seems cost neutral in the short term, but the probable prevention of neurological morbidity and reduced need for preoperative neonatal intensive care suggest that such screening will be cost effective long term."
In an editorial in the same journal, Professor Keith Barrington from Canada's University of Montreal said the study suggested pulse oximetry was a low risk and low cost strategy for improving the detection of critical congenital heart disease.
He added: "Serious consideration should be given to its introduction wherever neonatal cardiac surgery is available."
Cathy Ross, of the British Heart Foundation said: "At the moment there are only a limited number of hospitals that would be able to carry out the necessary specialised echocardiograms required to confirm a diagnosis.
"Careful consideration will be needed as to how these practical and logistical problems can be overcome before this is widely offered in the NHS."
Source: BBC News, 01-16-10
Pulse Oximetry Screening on newborns - soon to become standard?
A test that measures oxygen levels in newborns can detect "critical" congenital heart disease, but there are variables involved with the test that require more study before it is adopted for universal newborn screening, according to a new joint statement from the American Heart Association and the American Academy of Pediatrics.
A critical congenital heart defect is one a child is born with that requires surgery or catheter intervention in the first year of life, such as Tetralogy of Fallot and Coarctation of the Aorta, among others. The benefits of the oxygen test, called a pulse oximetry screening, outweigh the risks, but the best way to implement pulse oximetry screening is not well established by research.Thus, the organizations affirm that the test can be used at a physician's discretion, and call for more research to determine whether the test should become part of the routine assessment of all newborns in the United States.
In the research reviewed, the test's ability to detect critical congenital heart disease varied widely, from zero to 100 percent. According to the statement, most studies that have analyzed pulse oximetry in newborn screening were relatively small, and screening protocols differed with respect to both age at screening and cutoff levels for an abnormal screen. A normal oxygen reading is between 97-100 percent. Because oxygen levels in healthy newborns can vary considerably in the first 24 hours of life, the authors note that testing after 24 hours would appear the best strategy. False positive rates were just .035 percent in infants screened after 24 hours. "The statement is important because there hasn't been any strong guidance so far regarding the use of pulse oximetry as a diagnostic technique in newborns," said William T. Mahle, M.D., FAAP, chair of the writing committee and associate professor of pediatrics at Emory University School of Medicine in Atlanta. "Some hospitals across the country have adopted it and others haven't, so we wanted to review the available evidence and offer a consensus opinion on the topic."
The test potentially can identify significant or life-threatening heart defects that may otherwise go unnoticed or at least unnoticed before a newborn is released from the hospital, Mahle said. Early identification of certain defects is important, and can allow doctors to begin appropriate treatment or transfer to a specialty hospital.
Pulse oximetry was developed in the early 1970s, based on the fact that red blood cells that carry oxygen absorb different wavelengths of light vs. those that don't carry oxygen. Oxygenated blood cells absorb infrared light, while deoxygenated cells absorb red light. The test measures how much oxygen is in blood that flows through the arteries. Arterial blood oxygen levels are measured by a device with a thin wire, tipped by a small red light. The wire is taped to an infant's foot for a few minutes to obtain a reading. In older children and adults, pulse oxygen is often measured by a device clipped on a finger.
The overall cost of the test is reasonable, and is about the same as the cost of other newborn screening tests.
Source: American Heart Association, 07-07-09
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