Blood Oxygen Test Finds Heart Defects in Newborns
Study Suggests That Pulse Oximetry Test May Help Screen for Heart Malformations
Aug. 22, 2011 -- All newborns should get a simple oxygen test to check for serious heart defects before they come home from the hospital, a federal advisory panel says.
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's heart and lungs continue 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 Alan R. Fleischman, MD, medical director of the March of Dimes in White Plains, N.Y.
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 (CHIN) and mother of a son with heart defects.
How Pulse Oximetry Works
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.
"It looks like a Band-Aid, with a little light probe where the center of the Band-Aid would be," says Dennis Davidson, MD, chief of neonatology at Steven and Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y.
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.
The test is mandated by law in two states: New Jersey and Maryland. In other states, some hospitals are doing it voluntarily, though it is not yet in widespread use, says study researcher Alex R. Kemper, MD, associate professor of pediatrics at Duke University.
In 2009, the American Heart Association and the American Academy of Pediatrics issued a statement supporting the promise of pulse oximetry screening, but they held off on endorsing its widespread use, pending more research to determine what numbers should be considered normal and abnormal and what the next steps should be for babies who failed the test.
Kemper and 10 other experts were asked by the Health and Human Services Department's Advisory Committee on Heritable Disorders in Newborns to develop a plan to put pulse oximetry screening into effect.
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.