It takes less time to complete this examination than to undress a child, and its importance cannot be overestimated: it can save lives. Pulse oximetry, i.e. the measurement of blood oxygen saturation, will check whether the toddler’s circulatory system is really working properly.
The British project covered over 20 children. His results indicate that by performing pulse oximetry – testing the oxygen levels in the blood – it would be possible to identify congenital heart defects in good time and save many lives. Current tests for these conditions include an ultrasound during pregnancy and a routine physical examination 24 hours after birth – but this often fails to detect serious cardiac defects. Midwives in six West Midlands maternity units used the PulseOx test. It is carried out by placing a small sensor first on the handle and then on the child’s leg. Newborns with low blood oxygen levels shortly after birth are at increased risk of developing heart defects. Children whose test results were below the norm had an ultrasound of the heart. Of the 196 newborns with a poor test result, 26 had serious congenital heart defects, and a further 46 had other health problems that required urgent medical attention, such as respiratory problems and infections that were picked up early through the study. Under different circumstances, many of these newborns would develop serious complications that could even lead to death.
Congenital heart disease is one of the leading causes of infant death in developed countries, affecting one in 145 babies born to the world in the UK. Examples of diseases include hypoplasia, or underdevelopment of part of the heart, blockages that prevent normal blood flow, defects in the valves and holes in the heart where blood leaks from one side of the organ to the other. Early diagnosis allows doctors to surgically heal or reduce the defect, or to plan an appropriate treatment. The study, the results of which were published in The Lancet, ran from February 2008 to January 2009 and is the most comprehensive study of neonatal tests for congenital heart defects conducted in the UK to date. The test detected three-quarters of all critical cases. Combined with ultrasound and physical examination, the detection rate of major heart defects has risen to 92 percent. None of the children died of undiagnosed cause. (…)
Dr. Andrew Ewer, head of the research team at the University of Birmingham, described the project as convincing evidence in favor of routine neonatal screening. He added that if we extrapolate the results to the entire population, each year 200 children who were considered healthy with potentially fatal congenital heart defects could be diagnosed.
“It takes longer to undress a child than to conduct the examination itself,” remarked Dr. Ewer. – We have proved that the test is useful. We would like all newborns to be routinely screened. This way, it is possible to track down those children who would otherwise become seriously ill or die. We have sufficient evidence to suggest that pulse oximetry should be incorporated into everyday clinical practice.
Amy Thompson, senior cardiac nurse at the British Heart Foundation, emphasized that early and timely detection of the defect is key to increasing the chances of a newborn’s survival. – Not all babies born with a heart defect develop disturbing symptoms, so the problem can be overlooked. This promising study shows how a simple test can help diagnose and save lives, she said.
Two US experts commenting on a British colleague’s article in The Lancet agreed that while introducing new neonatal tests in general requires careful consideration, the PulseOx test deserves routine implementation. “Healthcare systems in developed countries are already under an enormous strain,” wrote Dr. William Mahle of the Emory University School of Medicine in Atlanta and Dr. Robert Koppel of the Cohen Children’s Medical Center in New York. “But the compelling arguments from data by Ewer and his team support the inclusion of pulse oximetry in neonatal care.”
Text by Sam Lister