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Newborn heart defect screening urged

05/01/2012 06:04 EDT | Updated 07/01/2012 05:12 EDT

Newborns should be screened for heart defects using a simple, non-invasive test, a new review finds.

Heart defects present at birth are a leading cause of infant deaths. Surgery improves survival of serious cases but newborns may not show signs of the condition early.

For years, hospitals in developed countries have considered using pulse oximetry — a measure of the oxygen circulating in the blood stream using a sensor commonly placed on the toe or fingertip — to alert staff to low levels that could signal a heart defect.

In Tuesday's online issue of the The Lancet, British researchers analyzed data from studies on 229,421 newborns to see how well pulse oximetry stacks up as a screening method for congenital heart defects in seemingly healthy newborns.

"Heart defects in newborn babies are thankfully rare but their potential impact is devastating,” said Dr. Shakila Thangaratinam, a clinical senior lecturer at Queen Mary University of London, who led the research.

"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," she added in a release.

Thangaratinam and her co-authors concluded pulse oximetry should be included in universal screening of newborns.

Blue babies

Currently, doctors rely on prenatal ultrasounds and physical exams of the newborn to detect the heart defects but both techniques have a fairly low detection rate and many babies are discharged from hospital before diagnosis, the researchers said.

Pulse oximetry aims to pick up on newborns with low oxygen levels that wouldn’t necessarily create visible cyanosis — a "blue baby" with a clinically detectable problem.

The reviewers included newborns without symptoms who were screened for critical congenital heart defects that could kill the baby or require invasive procedures like surgery in the first 28 days of life.

Greg Beros's son Jesse is grateful that pulse oximetry alerted staff at York Central Hospital to a heart defect that needed immediate surgery at the Hospital for Sick Children in Toronto.

After a normal pregnancy and delivery, Jesse was born on October 30, 2008. When he was tested, the "bells and whistles went off," his father recalled to the hospital in an article published by Hospital News. AfterJesse was stabilized, he had open heart surgery to correct how oxygenated blood is pumped in his body and is now thriving.

However, not all hospitals in Canada routinely give pulse oximetry to newborns.

Screening endorsement

The review suggested that the non-invasive and easy screening works best when done after 24 hours of birth.

The U.S. is adopting pulse oximetry screening. New Jersey became the first state to implement state-wide screening of newborns in August 2011.

Last year, the American Academy of Pediatrics, American College of Cardiology Foundation and American Heart Association jointly endorsed pulse-oximetry screening in most newborn care settings.

The U.S. groups called for more research on special populations such as at high altitudes and during telemedicine deliveries and for nurseries without echocardiography services to take an ultrasound of the heart on site.

The Canadian Pediatric Society said it does not have a position on adopting pulse oximetry to routinely screen newborns.

The screening isn't foolproof. Pulse oximetry can miss critical heart defects in some babies, the reviewers noted.

Adding pulse oximetry could also have an added benefit in identifying other serious disorders such as group B streptococcal pneumonia, they said.

A journal editorial accompanying the research said it provides "convincing evidence for introduction of this technique as a screening method in clinical practice."

There was no funding for the research.

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