A federal advisory provides screening at the national level for critical congenital heart disease using pulse oximetry, a simple, painless test to measure oxygen in the blood.
Before leaving the hospital newborn should receive a simple, painless test to check for signs of congenital heart disease, one of the most common types of birth defects, according to the recommendation of a federal advisory panel.
In a report published Sunday online in the journal Pediatrics, doctors offer screening at the national level for critical congenital heart disease using pulse oximetry, a probe placed in one hand and a foot with a light source and a sensor for measuring oxygen in the blood. Low oxygen levels signal the need for further testing for a heart problem.
Many questions remain about how best to implement screening tests, the issue was pushed on stage by parent groups who support theNational. In addition, some states - which have jurisdiction over the projections of newborns - have acted on their own to run the programs. New Jersey and Maryland recently passed a law requiring a review of pulse oximetry, and similar projects are being considered in other states.
Congenital heart defects involve the walls, valves, arteries and veins in the heart and occurs in 7-9 of every 1000 live births in the United States. About a quarter of these children have a serious illness, said Dr. Alex Kemper, an assistant professor of pediatrics at Duke University and lead author of the report.
"Mistakes are what really need for early intervention in life," he said. "The challenge is that the baby may be born with one of these heart defects and appear perfectly normal in the nursery. But if you can fix these children before they are really sick, have better results."
In many cases of critical congenital heart disease associated with blood vessel called the ductus arteriosus. This vessel passes into the lungs when the baby in the womb, and closes shortly after birth. But in some cases, remains open. If undiagnosed, the condition can cause organ damage or death. Condition and other critical congenital heart disease can be treated with medications or surgery.
"Over the past three decades, there has been an amazing progress in treatment," said Dr. Gerard Martin, co-director of the National Heart Children in Washington, who is a pioneer in the use of pulse oximetry screening of newborns. "It is a disease that we can do something about it. The problem is not all children are identified."
Research shows about 1 in 6 children die from congenital heart disease is essential undiagnosed and unrecognized thought to cause about 200 infant deaths each year, he said. An estimated 2,000 children a year are diagnosed earlier if the pulse oximetry were used routinely.
The disadvantage of pulse oximetry screening is that, while clearly useful in detecting the disease, but can also lead to false positive results that are expensive and stressful for the family. However, several large studies in Europe, including a study of more than 20,000 babies in the UK published this month in the medical journal The Lancet showed that pulse oximetry had a high detection rate when added to standard tests and a false positive rate of about 1 in 3,000 cases, said Martin.
"Hospitals that use pulse oximetry as an adjunct to physical examination can increase their detection of these babies increased tenfold," says Martin. "There will potentially miss some babies. But what the European studies have shown infants who had false positives had other problems involving the detection and treatment."
However, false positives are of concern because smaller hospitals may be a means to build sophisticated cardiac testing, which requires the transfer of some children in need of further testing that might prove unnecessary.
"False positives are particularly bad because all the hospitals and nurseries will have access to pediatric cardiologists and pediatric echocardiograms," said Kemper. "We want to minimize unnecessary testing."
The new report, which was adopted at the American Academy of Pediatrics, American College of Cardiology Foundation and the American Heart Assn., Is now in the hands of Health and Human Services Secretary Kathleen Sebelius. The panel suggests that a screening protocol that combines pulse oximetry with the usual medical examination, the authors said. To maximize the accuracy of the results, the report recommends screening for newborns on the second day of life, rather than 12 hours after birth, the method is tested in some studies.
The report also recommended limits on what is considered low oxygen saturation. However, these figures do not translate well to high altitude, which naturally decreases the oxygen saturation, the report said.
In addition, hospital nurseries to adopt the recommendations, the need to purchase equipment and testing to create a system to test babies and refer those who need further evaluation. Some hospitals have already adopted pulse oximetry. But others are likely to await the recommendations of state newborn screening programs, Martin said.
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