Checking for Newborns' Healthy Hearts

Heart defect screening for newborns could be done safely and cost effectively at birth

(RxWiki News) While your newborn baby likely steals your heart from the moment you see him, you also want to be sure his heart is in tip-top working order. A simple screening may tell you.

A recent study from England has provided evidence supporting the practice of screening newborn babies for heart defects at birth using a method called pulse oximetry.

"Screening for heart defects is recommended for newborns."

Dr. Shakila Thangaratinam, a clinical senior lecturer at Queen Mary, University of London, led the research project that pulled together the results of 13 individual studies looking at the value of newborn screening for cardiovascular problems.

The studies include data on just under 230,000 babies and found that using pulse oximetry identified 76.5 percent of heart defects in babies.

Pulse oximetry is done by using small device that fits over a person's finger and measures the level of oxygen in the person's blood. An abnormal reading could alert doctors to an underlying heart problem they could determine through additional assessments.

Dr. Thangaratinam's article recommends including pulse oximetry screening for heart defects with the other standard screenings that are done when a baby is born.

The studies Dr. Thangaratinam pulled together showed that the pulse oximetry screenings are most accurate when conducted approximately 24 hours after birth.

False positive readings - in which an apparently low reading of blood oxygen might point to a heart problem when there actually is not one - are possible but happened rarely in the studies reviewed by Dr. Thangaratinam.

If pulse oximetry did pick up a reading pointing to a suspected heart defect, doctors would conduct additional studies, so the most likely side effect of false positives would be the stress (and costs) of giving the newborn another test.

According to John Loyd, a neonatologist and the medical director of the NICU of Seton Medical Center in Austin, Texas, a positive reading for low oxygenation in the blood on a pulse oximeter would lead doctors to do an ultrasound of the heart called an echocardiogram to look for the cause of the low oxygen reading.

The cost of using pulse oximetry itself should be negligible and has been shown to be cost-effective in previous studies, according to Dr. Thangaratinam. A typical pulse oximeter could range from $29 to $240, so hospitals should not charge an excessive amount for the reading that would take a minute or less.

Dr. Loyd also said that the cost of adding this screening to the standard of care for newborns would be very small, but costs could grow - including for false positives - in areas without the standard medical equipment found in cities.

"They would need access to an ultrasound to diagnose or rule out heart disease," Dr. Loyd said. "In rural or remote areas, the logistics are going to be challenging because the family will need a means of transport to a center with an ultrasound machine."

Dr. Loyd said pulse oximetry is already being used in many places to screen newborns for heart problems, and he said widespread adoption of it is probably inevitable.

Some types of heart defects can already be detected by a physical examination of a newborn or by ultrasound scans conducted when women are approximately 20 weeks pregnant.

Since many can still be missed by these screenings, however, a pulse oximetry screening at birth would provide another way to find out if a baby may have a life-threatening defect that could be more immediately treated.

"Heart defects in newborn babies are thankfully rare but their potential impact is devastating," said Dr. Thangaratinam. "This study is really important because by including such large numbers of babies, we can show that pulse oximetry is effective at picking up defects, without misdiagnosing healthy babies."

The study was published online May 1 in The Lancet. Information regarding funding or possible conflicts of interest was not available.

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Review Date: 
May 1, 2012