Screening Newborns for Critical Congenital Heart Defects (CCHD) Pulse Oximetry— A Life-Saver
CONGENITAL HEART DEFECTS (CHDs)
Congenital heart defects (CHD) are structural abnormalities of the heart that are present at birth. These defects range in severity from simple holes or murmurs to severe malformations, such as the complete absence of one or more chambers or valves.
Some heart defects are minor and an individual may never exhibit symptoms. Others are critical and require detection and intervention within the first days of life.
Babies with a Critical CHD are at significant risk for death or disability if they are not diagnosed and treated soon after birth. Each year in the United States, between 100 and 200 babies die of unrecognized CCHD. Those newborns who survive a delayed diagnosis may have more complications when their heart disease is treated than infants who are diagnosed promptly.
CURRENT SCREENING METHODS
Current methods for detecting congenital heart defects include prenatal ultrasound and clinical examination of the newborn. However, these screenings alone are not sufficient to diagnose all cases of CCHD. In many cases, babies with CCHD may have normal physical exams in the first days after birth and outwardly healthy infants may be discharged from the hospital before signs of the defect are detected. It is estimated that 50-60 percent of CCHD cases will be identified by prenatal ultrasound and 20-25 percent of cases will be detected by physical examination. That leaves up to 30 percent of CCHD cases unidentified by current screening methods.
CONGENITAL HEART DEFECTS IN WISCONSIN
In 2010 there were 68,367 live births to Wisconsin residents. Given the statistics, that means approximately 544 babies were born with a CHD and 136 of them were critical and required early detection and intervention. With up to 30 percent of CCHD cases going undetected in the delivery center, that means nearly 40 newborns in Wisconsin may have been discharged in 2010 with an undiagnosed critical congenital heart defect.
According to one Wisconsin specific study, in Wisconsin from 2002 to 2006, at least 9 neonates died at home or in an emergency room due to previously unrecognized critical congenital heart disease.
PULSE OXIMETRY SCREENING
Fortunately, an emerging body of evidence suggests that measuring blood oxygen saturation via pulse oximetry can lead to early diagnosis and detection of CCHD. Once detected, many heart defects can be surgically repaired. It is estimated that 85% of neonates who undergo surgery for CCHD will reach adulthood.
- Pulse oximetry, when performed on newborns in the delivery center, is effective at detecting life-threatening critical congenital heart defects which may otherwise go undetected by current screening methods. It is a simple, low-cost and non-invasive test that can be completed by a technician in as little as 45 seconds. A probe with a small light is attached to the babies hand and foot with a band aide like adhesive. It does not puncture the skin and is attached to a special monitor that shows the results. Pulse oximeters area available in most neonatal units, and hospital staff are well trained in how to perform pulse oximetry screening.
- Pulse oximetry is cost effective and offers a positive return on investment. A recent cost-effectiveness analysis estimated that universal newborn pulse oximetry screening would cost just under $4 per infant. Research suggests that the cost savings associated with early detection of a single case of CCHD could exceed the costs associated with screening two thousand infants.
The American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the American College of Cardiology Foundation (ACCF) recently outlined recommendations for a standardized pulse oximetry screening approach and diagnostic follow-up.
According to the recommendations, screening should be performed on asymptomatic newborns after 24 hours of life in order to avoid false-positive results. When the screening identifies newborns with low blood oxygen concentration, additional testing can be completed to detect heart defects or other life-threatening conditions. Roughly 25 percent of infants identified as having low blood oxygen without CCHD may be diagnosed with other conditions that require medical intervention.
WISCONSIN LEGISLATION TO CCHD SCREENING INTRODUCED
Senator Jerry Petrowski (R—Marathon) and Representative Joel Kleefisch (R—Oconomowoc) introduced Senate Bill 104 and Assembly Bill 111, legislation to ensure all babies born in Wisconsin are screened for Congenital Heart Defects (CHD) prior to hospital discharge. Evidence indicates that performing a pulse oximetry screening on newborns would help prevent babies with unrecognized critical congenital heart defect from going home, only to have serious complications and require emergency care soon after.
This legislation is supported by the American Heart Association, Mended Little Hearts, March of Dimes, Children’s Hospital of Wisconsin, UW Health American Family Children’s Hospital, Marshfield Clinic, the Wisconsin Chapter of the American College of Cardiology, the Wisconsin Chapter of the American Academy of Pediatrics, and the Wisconsin Nurses Association. Legislation introduced press release
THE AMERICAN HEART ASSOCIATION (AHA) ADVOCATES
The AHA is committed to advancing public policies that will allow children and adults with heart defects to live longer, fuller lives. These policies include State adoption of uniform CCHD screening using pulse oximetry for all newborns.
Wisconsin Pulse Oximetry Screening Fact Sheet (download)
Wisconsin Pulse Oximetry Screening Letter of Support (download)
For more information, please contact:
Nicole Hudzinski, Government Relations Director, (608) 225-4042
American Heart Association, 2850 Dairy Drive, Suite 300, Madison, WI 53718