By Carissa M. Baker-Smith, MD, MPH
Assistant Professor, University of Maryland School of Medicine
Pediatric Cardiologist, University of Maryland Children’s Heart Program
A quick, painless and non-invasive test to determine the amount of oxygen in a newborn baby’s blood is a first step in screening infants for congenital heart defects. Beginning September 1, 2012, hospitals in Maryland must administer the test to all newborns.
Congenital heart disease (CHD) occurs in approximately 8 of every 1,000 children. Infants born with congenital heart disease have structural defects of the heart. Approximately 25% of all CHD cases are critical and require intervention during the infant’s first month of life. Interventions can include the administration of special medications or even surgery. Pulse oximetry may be helpful in improving the detection of critical CHD (CCHD).
On September 1, 2012, hospitals across Maryland begin mandatory pulse oximetry screening for all newborns. The screening must be done by a health professional before the infant is discharged and within 24 to 48 hours after birth. All hospitals in Maryland will be responsible for creating and implementing pulse oximetry screening protocols.
Children who “fail” pulse oximetry screening will undergo further evaluation, and their primary care providers will work closely with pediatric cardiologists to make the correct diagnosis. Failing the pulse oximetry test means oxygen saturation is lower than normal without another explanation, such as infection or lung disease.
What is pulse oximetry?
Pulse oximetry relies on the use of a non-invasive, painless method for detecting the amount of oxygen in the blood. Probes are applied to the palm of the hand and the sole of the foot. The protocol selected by the State of Maryland for screening is published in the Journal of Pediatrics (Pediatrics 2011; 128; e1259). Children with oxygen saturation less than 90% automatically test positive and fail screening. Children with oxygen saturation greater than 95% test negative and pass screening. Children with oxygen saturation between 90% and 95% will undergo repeat testing and evaluation.
What is the potential impact of pulse oximetry screening?
We anticipate that pulse oximetry screening will enhance detection of CCHD. Data indicate that for every 1,000 children born in Maryland, 2.3 have CCHD. Currently, between 60% and 70% of these infants are diagnosed through prenatal screening, leaving approximately 30% who are not yet diagnosed by the time they are born. Combined with physical examination, pulse oximetry is reported to improve sensitivity for detecting CHD by 20%.
What is the role of the Children’s Heart Program?
The University of Maryland Children’s Heart Program offers a comprehensive panel of services designed to accurately diagnose and effectively manage and treat children with CHD and CCHD. Pediatric cardiologists are available 24 hours a day, 7 days a week, to assist with the diagnosis of CHD. Through consultation and telemedicine services, the Children’s Heart Program is ready to assist surrounding providers and families with the evaluation of infants with suspected CCHD.
For more information on pulse oximetry, please contact the Children’s Heart Program at 410-328-4FIT (4348).
Dr. Baker-Smith is a member of the Maryland State Advisory Council’s Committee for CCHD and the Newborn Screening for Critical Congenital Heart Disease multi-institutional group.