Blood Oxygen Test Finds Heart Defects in Newborns
Study Suggests That Pulse Oximetry Test May Help Screen for Heart Malformations
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.
The panel's plan 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, Fleischman says.
While the test itself is easy and inexpensive, Barmash says it is the prospect of what to do with a positive result that concerns smaller hospitals that 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,'" Barmash tells WebMD.
But she says the test has a low false-positive rate -- less than 1%. And there are other questions to be answered.
For example, Kemper says doctors are not sure that the oxygen test result cutoffs should be the same for all areas. In places at high altitude, for example, where there's less oxygen in the air, it could be that the cutoffs should be adjusted.
But even as an imperfect tool, studies suggest the test could save lives.
"If you look at data out of California," says Kemper, "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."