May 18, 2012

DFW hospitals test for life-threatening heart defects in newborns

A new, simple screening in North Texas hospitals could save the lives of newborns who would otherwise be discharged with undiagnosed, life-threatening heart conditions, medical experts say.

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A new, simple screening in North Texas hospitals could save the lives of newborns who would otherwise be discharged with undiagnosed, life-threatening heart conditions, medical experts say.

Congenital heart defects are the leading cause of birth-defect-related infant deaths, according to the Centers for Disease Control and Prevention.

Babies with undetected critical heart defects can fall dangerously ill, suffer brain damage and die during their first days or weeks, officials say.

Last year, federal health officials recommended that all newborns undergo pulse oximetry screenings, which measure oxygen in the blood and pulse rates, before they are sent home.

Low blood oxygen could indicate a critical heart defect.

Texas Health Harris Methodist Hospital Fort Worth started the screenings Jan. 1 and other Texas Health Resources hospitals have followed or soon will, spokeswoman Megan Brooks said. Andrews Women's Hospital at Baylor All Saints Medical Center in Fort Worth will begin the screenings in the next few weeks, a spokeswoman said.

"Historically, there has not been a great way to detect these kinds of problems before babies get sick," said Dr. Fran Lynch, associate medical director of the neonatal intensive care unit at Texas Health Harris Methodist. "This will help us identify them before they leave the hospital."

About 4,800 babies born in the United States each year have one of seven critical heart defects, known collectively as critical congenial heart disease, federal health officials say. So far, screenings at Texas Health Harris Methodist have detected low blood oxygen in only one infant.

Newborns who go home with serious heart defects may not circulate enough blood to their bodies, Lynch said. They can go into shock, turn blue, have a drop in blood pressure, stop eating or struggle to breathe. Often they require emergency care.

A pulse oximeter is quick, painless, noninvasive and used at the mother's bedside. A nurse attaches sensors to the infant's hand and foot to measure blood oxygen. The test usually takes a minute or two, Lynch said.

If blood oxygen is low, the next step is usually an echocardiogram, or a sonogram of the infant's heart, said Alex Kemper, an associate professor of pediatrics at Duke University who wrote a study on the subject. A heart defect is not the only explanation for low blood oxygen.

Screenings have a low false-positive rate and detect about 75 percent of critical congenital heart defects, according to a review published this month in The Lancet, a medical journal. The review determined that the testing met the criteria for universal screenings.

The driving force behind the recommendations was the difficulty in detecting the defects in hospital nurseries, Kemper said. Once a diagnosis is made, potential treatments include medications and, in some cases, surgery, he said.

"The challenge is that these babies usually look completely normal," he said. "They go home and have changes that cause them to get rapidly very sick. If you intervene quickly, before they go home from the nursery, you can greatly improve positive outcomes."

Kemper said the screenings cost $10 to $15 per infant, but the tests save money in the long run by eliminating the need for more costly procedures. The test is highly accurate at least 24 hours after birth, he said.

Some hospitals could face challenges as they phase in screenings, he said. Some medical centers, especially rural ones, don't have access to echocardiogram services.

"In some rural areas, they're experimenting with telemedicine so a cardiologist can read the echocardiogram without transferring the baby, which is expensive and hard on the families," Kemper said.

Also, babies in higher altitudes naturally have lower oxygen levels, but that shouldn't be a problem in Texas, he said.

Alex Branch, 817-390-7689

Twitter: @albranch1

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