19 April 2012

Simple Test for Babies to Determine Heart Problems

Story first appeared in the Detroit Free Press.

It's a simple test, but it can make a life or death difference for newborns with a previously undiscovered heart defect. Pulse oximetry in infants -- a variation of the finger-clip test many Americans get to determine whether the heart is pumping blood effectively -- is being added in U.S. hospitals -- including a dozen in Michigan -- as a common newborn screening tool.

There's also a push here and in other states to pass laws, as Indiana and Maryland have, to require the test, according to a support group, PulseOx Advocacy, which tracks the issue on its website.

A lot of newborns can be discharged without knowing they have significant problems with the heart. Each year, between 4 and 10 out of every 1,000 children born in the United States will have a congenital heart defect. Of those, more than 1,500 won't live to have a first birthday, according to the American Heart Association.

Fortunately, detection tools have improved so much that many of the problems are found by fetal ultrasound tests during pregnancy or during exams by pediatricians after birth. For those that are not found prior to birth, pediatric pulse oximeters make the difference.

One baby of 14,017 tested at the University of Michigan between 2006 and 2010 was diagnosed through pulse oximetry testing with a heart problem that otherwise would have gone undetected.

U-M has routinely offered the newborn screening since 2003 because it saw a benefit to the tests and, as a teaching hospital, had pediatric cardiologists readily on staff. Michigan doctors are working with the Michigan Department of Community Health to create a statewide system so that babies born at hospitals without pediatric cardiologists get the right, immediate follow-up if they flunk a pulse oximetry test showing that their hearts don't pump oxygen effectively.

In a smaller community hospital, we need to make sure cardiologists are available to see patients.

Most of the 60 Michigan hospitals that deliver babies have fewer than 1,000 births a year and of those, half have fewer than 500 births -- places unlikely to have pediatric cardiologists on staff.

Michigan applied for a $300,000 federal grant to gather statistics about the screening and follow-up tests and treatment.

The project also will look at whether there are more inaccurate readings -- usually suggesting a problem that isn't there -- if the pulse oximetry test is performed after the first day of life, as is done in England without big problems.

2-minute test
Over the past few months -- and as recently as last week -- metro Detroit hospitals adding the test include Hutzel Hospital, Detroit; St. John Providence, Southfield, and St. Joseph Mercy Oakland, Pontiac, according to doctors and hospital spokespersons.

Others expect to start soon, including the Oakwood Healthcare system in Dearborn, St. Mary of Livonia and Beaumont Health System based in Royal Oak, spokespersons said.

Pulse oximetry is best at finding heart defects that result from poor oxygen circulation in the blood. It's usually performed 24 hours after a baby is born -- while most infants still are in the hospital. If the test picks up something suspicious, it often is repeated once or twice within the next few hours.

It's recommended that babies discharged before 24 hours after birth get the test within a few days at their pediatrician's office.

The tests take about two minutes. Sensors are attached with tape to a baby's hand and foot. St. John Hospital spent $16,900 to buy new motion-resistant machines for its labor and delivery unit.

Proponents hope to get the Michigan Lt. Governor to help push for mandatory testing. His then-15-month-old daughter underwent open-heart surgery last May for a congenital heart defect.

The Lt. Governor who has another child with autism, played a similar role recently in the passage of legislation to require insurance coverage for autism care.

For now, the Michigan Governor's office said it will review any legislative proposals and is working with hospitals to develop a coordinated system.

Push for a testing law

Several local groups, including Hearts of Hope, support a state testing law involving pediatric pulse oximeters.

A  Royal Oak woman's son, now 3 1/2, was born with a hole in his heart and a narrowing of a key valve and artery. The condition left him too weak to breastfeed. After he lost a pound of his birth weight and continued having nursing problems, she brought him to his pediatrician, who recommended he see a pediatric cardiologist.

When the diagnosis came, it was like the air shifted in the room.

He had heart surgery when he was just 9 months old. Today, he's doing fine, loves his gymnastics class and calls his younger brother his best friend. His long chest scar is nearly gone and he has stretched his follow-up appointments with a Beaumont pediatric cardiologist to every two years.

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