A potential lethal health condition of newborns may now be more preventable, according to a recent Duke study.
Congenital heart disease is an abnormality of the structure of the heart that occurs in approximately one in every 120 newborns, said Dr. Alex Kemper, associate professor of pediatrics at Duke Medicine and lead author of the study. His research—published in the journal “Pediatrics” Aug. 22—explored the use of the pulse oximetry test. The method involves measuring the blood oxygen level to provide a more accurate way to detect CHD earlier in newborns, even before they leave the hospital.
“[The newborns] look completely fine, but if you send them home, there is a risk that they could die,” Kemper said.
In order to prevent those situations, pulse oximetry can help detect low oxygen levels in the blood of newborns, Kemper noted. In the test, a light placed above the skin will detect the color of the blood, and the color will then be compared to a standard one established for normally oxygenated blood. Lower oxygen levels indicate that there may be a heart defect, Kemper said.
Pulse oximetry should be performed at least 24 hours after birth. The time frame will minimize false positives that can occur if the test misreads normal changes as a defect, Kemper added.
“All these amazing physiological things happen after birth—you just want to make sure that you’re not capturing that,” Kemper said.
Last month, New Jersey required all hospitals to start screening for CHD using pulse oximetry. Hospitals in 11 other states are also ready to use this method routinely, Kemper said. Duke University Medical Center is currently making preparations to implement pulse oximetry for newborns.
Kemper estimates that it costs approximately $10 per each test.
“It is a relatively cheap and easy thing that can save the life of babies,” Kemper explained.
If a child is diagnosed with a heart defect, an echocardiogram—a scan of the heart—is used to determine the specific nature of the condition.
“Depending on the type of defect, there are certain medications you can use to keep certain vessels open... to help keep the baby well oxygenated, but that is just a temporary measure,” Kemper said. “These babies will need surgeries.”
Annamarie Saarinen, chair of the board for the Newborn Coalition, an advocacy group for the health of newborns, had a daughter who was diagnosed with CHD when she was 2-days-old.
Saarinen’s daughter was then put on medication and subjected to surgery three to four months later.
“We pushed [the surgery] to that point to where she has gotten bigger and stronger and had more weight on her,” Saarinen noted. “This happens all the time with critical heart patients, where you walk that tight rope. You don’t want to have a surgery when they are a newborn in those first days or weeks because they are so fragile.”
Saarinen supports greater use of pulse oximetry in hospitals.
“It’s a long overdue method,” she said. “I’m extraordinarily gratified that hospitals are latching on to it and moving forward.”
Pulse oximetry may benefit newborns, but it remains unclear whether early detection will improve their chance of survival, Dr. Jennifer Li, division chief of pediatric cardiology at Duke Medicine, wrote in an email Tuesday.
“There will be false positives with pulse oximetry as well,” Li said. “And no one knows how to pay for this in the era of health care reform.”
Get The Chronicle straight to your inbox
Signup for our weekly newsletter. Cancel at any time.