Seattle Children’s supporting efforts to implement universal screening for heart disease in newborns
Pulse oximetry has the potential to identify problems early and save lives
With a new recommendation for hospitals to screen all newborns for critical congenital heart disease (CCHD) using pulse oximetry, Seattle Children’s Heart Center is stepping up to help delivery hospitals in Washington state adopt this standard and educate pediatric practitioners on what to do when they are faced with a positive screen.
Prenatal ultrasound leads to the detection in utero of about half of all babies with critical congenital heart disease. The other half show physical signs after birth, but sometimes not until after they are discharged from the hospital. This late presentation, which can occur days or even weeks later, puts them at risk for significant morbidity and even death. Last September, the United States Department of Health and Human Services recommended hospitals screen every newborn for CCHD using pulse oximetry, and in late December, the American Academy of Pediatrics endorsed this recommendation. The test is intended to catch cases of CCHD in those infants who initially appear healthy.
Pulse oximetry is a simple, painless, noninvasive diagnostic tool currently used in hospitals and clinics on a daily basis. It shows how much oxygen is in an infant’s blood. Low oxygen, called cyanosis, is a common feature of many critical forms of congenital heart disease. While severe cyanosis is visible, not all forms of CCHD are accompanied by a visible degree of cyanosis. The new guidelines call for universal pulse oximetry screenings at least 24 hours after birth and prior to discharge from the hospital, similar to the newborn hearing screen.
“Over 70 hospitals deliver babies in Washington state. The majority are in the process of implementing this recommendation, and a few already have. This is great news. One of the challenges of universal implementation however is what to do with a positive screen,” said Meg Vernon, MD, a cardiologist at Seattle Children’s.
To that end, Children’s is using its extensive experience as the region’s primary pediatric care center for treating CCHD to develop resources for providers at delivery hospitals so they know what to do in the event of a positive screen, which is anticipated to occur in about 1 in 500 babies. In this situation, a pediatric echocardiogram is recommended, yet many smaller hospitals lack this capability. Children’s cardiologists can coordinate this test at one of its many regional telemedicine sites across Washington state. These locations transmit images digitally to Seattle, allowing Children’s cardiologists to consult across the state and, if necessary, arrange for a transfer of care. In addition, Children’s cardiologists are conducting visits to delivery hospitals, giving presentations and sharing their knowledge, all in an attempt to provide the best care possible for newborns.
An additional concern is what to do about those newborns not delivered in hospitals. In this state, over 1,500 babies are delivered at home, with another 1,000 in small birthing facilities. Since most of these births are attended by a midwife, Children’s is working to develop a plan for screening these babies.
Congenital heart disease on a whole is the most common form of birth defect and the leading cause of infant death among the 4.2 million babies born in the United States each year, including 86,000 born in Washington state in 2010. Critical congenital heart disease accounts for only a fraction of all congenital heart disease, however the Heart Center at Seattle Children’s cares for over 100 newborns each year with this diagnosis. “Thankfully, their prognosis has greatly improved over the years. Today, nearly all have a very bright future,” Dr. Vernon added.
“We want to see every newborn screened for critical congenital heart disease. Because pulse oximetry has been shown to identify healthy-appearing newborns who have critical congenital heart disease very early, it has the potential to save infant lives.”
About Seattle Children’s
Consistently ranked as one of the best children’s hospitals in the country by U.S. News & World Report, Seattle Children’s serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children’s hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Seattle Children’s has been delivering superior patient care while advancing new treatments through pediatric research. Seattle Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. The hospital works in partnership with Seattle Children’s Research Institute and Seattle Children’s Hospital Foundation. For more information, visit www.seattlechildrens.org or follow us on Twitter or Facebook.