Mandatory Pulse Oximetry Screening for Newborns Takes Effect in Maryland

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.

Back to Reality

By Sharon Boston
Media Relations Manager

Vivenne Rose talks with Shanice during her baby’s check up as the video crew records the action.

The University of Maryland Medical Center goes primetime on Tuesday, October 19 at 9:00 p.m. when the Discovery Health Channel airs “I’m Pregnant And…Morbidly Obese,” a show that followed one of our patients before and after her delivery.

The program tells the story of Shanice Glenn, a 26-year-old Baltimore woman who had a Body Mass Index of 53 (30 is considered obese) when she gave birth to her second daughter earlier this year. Shanice is a patient of Family Medicine physicians Dr. Vivienne Rose and Dr. Ada Orisadele.

The crew spent many hours with us, videotaping in several different locations including Family Medicine and the Mother/Baby unit. Watch the show to see if you can spot any places you recognize.

The show was originally scheduled to air in September, but the Discovery Health Channel postponed it until October 19.

Check out our previous blog with behind-the-scenes details of what happened when “Reality TV Came to UMMC.”

Other Posts By Sharon Boston:

Dr. Ahmet Baschat Becomes Couple’s Hero After Performing Surgery to Save Twins

After being diagnosed with Twin to Twin Transfusion Syndrome at a local hospital, Liz Tarallo was referred to Dr. Ahmet Baschat at the University of Maryland Medical Center’s Center for Advanced Fetal Care (CAFC). Dr. Baschat performed laser ablation surgery that saved the lives of Liz’s twin boys. In this video, Liz talks about her experience at the Medical Center and the excellent care she received from the entire CAFC staff, and explains why she and her entire family consider Dr. Baschat to be their hero.

UMMC Hosts First-Ever Online Video Chat

By Michelle Murray
UMMC Assistant Web Site Editor

Are you expecting twins? Wondering what you can do to minimize risks in complicated pregnancies?

It’s easy to get the answers: just log on and post your questions live on Friday, September 24 at 1 p.m. during our first-ever video chat with Dr. Ahmet Baschat, head of fetal therapy at UMMC’s Center for Advanced Fetal Care.

You can chat directly with Dr. Baschat, who will cover topics such as twin pregnancies, complicated fetal conditions and other maternal/fetal issues. Visit our video chat page to send in questions ahead of time and receive e-mail reminders, or just submit your questions live on the day of the chat.

Details:

When: Friday, September 24 at 1 p.m.
Where: www.umm.edu/webchat

In the coming months, we plan to feature other UMMC doctors, who will answer your questions on a variety of health topics. If you have ideas for topics you’d like to see covered, let us know by e-mailing us at: (webmaster.umms.org) And remember to tune in live on September 24th!

Reality TV Comes to UMMC

By Sharon Boston
Media Relations Manager

Kendra Johnson
Kendra Johnson was born at UMMC on April 25, weighing 7 lbs, 9 oz.

Meet Kendra Johnson, born at the University of Maryland Medical Center on Sunday, April 25, 2010, at 11:37 p.m. Kendra’s birth and her mother’s pregnancy are the subject of a Discovery Health Channel program called “I’m Pregnant And…,” a show that follows women facing particular challenges in their pregnancies.

For Kendra’s mother, 26-year-old Shanice Glenn, obesity put her at increased risk for complications in her pregnancy, such as diabetes and high blood pressure. Just before giving birth, Shanice weighed more than 270 pounds, with a Body Mass Index of 53. (A BMI of 30 or above is considered obese).

The program, called “I’m Pregnant And…Morbidly Obese,” follows Shanice through the final stages of her pregnancy and after delivery, as she works with Dr. Vivienne Rose and Dr. Adaku Orisadele from the Department of Family Medicine to have a healthy baby and then makes plans to get healthier herself by losing weight safely.

Here’s some behind-the-scenes scoop on what happened, including how the baby’s early arrival nearly sank the whole project. We’ll also let you in on what it takes to put together a half-hour reality show like this one and what you can look for when the program airs on Tuesday, October 19, on the Discovery Health Channel at 9 p.m.

Shanice Glenn with her sister
A videographer captures the action in the Mother/Baby unit the day after Shanice gave birth. In this photo, Shanice holds Kendra while talking to her sister.

How It All Got Started

In mid-April, our office received a call from the show’s production company, Sirens Media, with a request to follow Shanice, who was a patient of Dr. Rose and Dr. Orisadele. (They found Shanice when they put out a request to the American Society of Bariatric Surgeons, and a Family Medicine colleague forwarded the request to Dr. Rose).

Ideally, the crew wanted to videotape Shanice at her doctor’s appointments and in her hospital room before and after giving birth. They also wanted to videotape the delivery, which they would shoot discreetly. For a half-hour show, you need a lot of footage, and the delivery is often a key scene in the program.

Shanice, Dr. Rose and Dr. Orisadele were all on board for this. But, as you can imagine, a lot of other people needed to sign off on this before we would allow a crew in Labor & Delivery. (A member of the media relations team must always accompany any crew while they are in the hospital, so I had planned to be on-call and come in when Shanice gave birth if it happened at night or on a weekend).

For a production company like this one, there are also location release forms that need to be signed, so we had our legal department reviewing those while we worked on coordinating what we might be able to allow in terms of videotaping the delivery.

Can We Come Earlier?

Time is of the essence when you’re dealing with a pregnant mom. But, Shanice’s due date was May 4, so we thought we had some time. She had an appointment with Dr. Rose and Dr. Orisadele on April 30, so we were working to coordinate when the crew would arrive, where they would interview the doctors, etc. for that last day of April.

However, the week before, producer Diana Nolan called to say that Shanice had another doctor’s visit on April 23, and the crew wanted to come for that too. Could we make that happen?

Shanice would have a long day of tests and appointments, and the crew wanted to be there for any and all of it, and they kept coming up with more questions and more requests. Along with the doctor visit, could they videotape Shanice’s fasting glucose test? What about her ultrasound? How long would her appointment last? What kinds of things would she be doing in the appointment? Could they videotape outside the hospital? What do our signs say? And so on.

To make this happen with just a day or two’s notice, I was making dozens of phone calls and sending lots of e-mails. The appointment would take place at a different location than the delivery, requiring a separate location release and a different team of lawyers, and we were literally faxing the final forms while the crew was driving here from the D.C. area.

At the time, it seemed very last-minute and somewhat stressful, but with the help of the folks in Family Medicine, OB/GYN and two legal departments, we were able to get this arranged.

And, as you’ll read later, it’s a very good thing we pushed to get the appointment videotaped that day!

Taping Day

Even though Shanice’s appointment wasn’t until midday, the crew arrived in the morning so we could be outside filming “establishing shots,” such as the hospital exterior, the outside of Family Medicine and signs that say “University of Maryland Medical Center.” The producers could use them as transitions between scenes and as a way to establish where the action is taking place.

The interviews from this day would provide much of the main narrative for the show, so they had to look and sound great. The crew brought a huge cart of video equipment, which we needed to keep out of the way of the medical staff and other patients. Diana was there along with a videographer and sound technician. Later in the day, another producer joined the team.

The crew interviewed both Dr. Rose and Dr. Orisadele separately. The producers commented that both doctors were fantastic and could explain, in simple language, why Shanice’s weight put her and her baby at increased risk for medical complications.

The doctors also talked about some of the social pressures that can make losing weight a challenge. After the interviews, the crew videotaped Shanice’s appointment with Dr. Rose and Dr. Orisadele. At one point, there were eight people, including Shanice, in the exam room!

With that Friday appointment and a long day of shooting behind us, we decided to regroup on Monday and talk about the plans to shoot Shanice’s next appointment and the delivery, which was still a week-and-a-half away. However, baby Kendra had other ideas.

Early Arrival

Monday morning I awoke to find two voicemails and a text message on my cell phone from Diana. Shanice had gone into labor the night before, and Kendra had been born without complication just before midnight.

Luckily, we had pushed to get the footage on Friday! Without that, the whole program would have been scrapped. Shanice’s family also had some home video from the night before, which they would give to the production company, so the producers thought they would have enough to continue the project.

By 9 a.m. on Monday, Diana and I were planning what to do next. The production team wanted to come that day to interview Shanice and get footage of her with Kendra. After a few phone calls, we had everything arranged, and Diana, her videographer and I spent several hours with Shanice, Kendra and their family in the Mother/Baby unit. The producers captured some wonderful interaction between Shanice and her nurses, but we’ll have to see how much of it makes the final cut.

Media Crew
The crew from Sirens Media documents Shanice and Kendra’s visit with Dr. Rose in Family Medicine. This appointment came just four days after Kendra’s birth and happened to be Shanice’s birthday.

Follow-up Visits

Just a few days after giving birth, Shanice was back for a check-up with Dr. Rose, and the Sirens Media crew and I were there right along with them. Dr. Rose checked on Kendra and talked to Shanice about breast feeding and eating right. They also talked about some strategies for losing weight long-term. Diana thought this would probably be the final day of shooting for Dr. Rose and the rest of us at UMMC.

Of course, the crew wanted to come back. They returned at the end of June to videotape another follow-up visit for Shanice and Kendra. One key scene for viewers will be to see if Shanice had been able to lose some weight in the two months after Kendra’s birth.

The Show

If you’ve ever watched “I’m Pregnant And…,” you know that the program takes a hard look at some difficult issues facing these pregnant women. We expect Shanice to be the main focus with Dr. Rose, Dr. Orisadele and the rest of staff playing supporting roles.

In watching all the interviews and spending time with Shanice, I was impressed by her openness, thoughtfulness and patience. She is an intelligent and caring woman, and I hope that comes across on the show.

Other Random Notes

If I had to estimate, I would say the crew spent about 15 hours with us for this production.

The producer told me some show topics they’ve covered include, “I’m Pregnant And… Homeless,” “I’m Pregnant And…Addicted” and “I’m Pregnant And…a Nudist.”

Kendra was born on a night with extremely strong thunderstorms, and Dr. Rose said she had a tough time driving to the hospital. In fact, Kendra came so fast that Dr. Rose did not make it in time for the delivery. Dr. Orisadele was there.

The production crew filmed Shanice’s baby shower. They also followed her as she went shopping for baby things.

Shanice has another daughter, a chatty 3-year-old named Kiyah, who kept us entertained with lots of questions and observations through two of the shoots. When asked who the new baby was, Kiyah emphatically told us, “That’s my sister!”

As a media relations manager, I am always there when a TV crew is videotaping. However, I do all I can to stay off-camera because, in reality, I wouldn’t be there. This time, I apparently didn’t do enough. Diana e-mailed about a month ago asking me to sign a release form because there is one shot where you can see me and our media relations intern in the waiting room of Family Medicine. The shot comes at the end of the show during Shanice’s final visit with Dr. Rose.

The episode of “I’m Pregnant and Morbidly Obese” featuring Shanice, baby Kendra and UMMC is scheduled to air Tuesday, October 19, at  9 p.m. on the Discovery Health Channel.

Other Posts by Sharon Boston: