Earlier this month, Cherokee Regional Medical Center joined a select number of Iowa hospitals to administer pulse oximetry tests to all newborns. The test is a painless procedure that measures how much oxygen is in the blood. Low oxygen levels could be a sign of serious health problems such as congenital heart disease (CHD). Even though some forms of CHD can be life-threatening, only about one-third of Iowa hospitals currently offer the screenings according to the American Heart Association.
The most common of all birth defects, congenital heart disease is a malformation of the heart which is present at the time of birth. CHD can involve problems in the heart chambers, heart valves or its major blood vessels. Congenital heart diseases can range from simple to complex and most can be repaired or improved with surgery.
With that in mind, pulse oximetry testing plays an important role in the early diagnosis and treatment of CHD.
"Cherokee Regional Medical Center is proud to take a leading stance in this important effort to provide earlier detection of serious, life-threatening conditions in our newborns," said Connie Mohn, Vice-President of Nursing and Regulatory at CRMC.
"We began looking into the possibility of proactively administering pulse oximetry tests to our newborns after studies indicated they could help in the early detection of congenital heart disease."
Pulse oximetry testing is a fairly simple procedure. A small sensor (similar to an adhesive bandage) is placed on the baby's right hand and left foot and then hooked to a machine, called an oximeter, to measure the oxygen level in the infants blood. Levels above 95 percent are considered to be normal. Readings below 95 percent, or anytime there is a difference of more than 3 percent in the hand and foot readings, merit additional testing. The tests are typically conducted 24-48 hours after an infant's birth to help assure the most accurate readings.
Darla McDonald, OB Nurse Supervisor at CRMC, is pleased with the process at this point. "The tests only take a few minutes to complete so they really have not affected our workload at all. When you consider the potential benefit of helping to diagnose a problem such as CHD, it really makes sense to perform the tests."
In addition to being easy to administer, the tests are fairly inexpensive. At Cherokee Regional Medical Center, the costs are included in the regular delivery and newborn care charges so parents really should not be impacted whatsoever from a financial standpoint.
Another positive aspect of pulse oximetry is that a test showing low oxygen levels may also be an indication of lung problems or infections altogether different from CHD. This is important because many newborns afflicted with these problems will appear to be doing well and not show any signs or symptoms until their condition worsens over time. Earlier detection typically improves outcomes in these instances.
While the screenings will certainly help identify more cases of CHD in newborns, it is important for families to understand the rationale for screening and the limitations of pulse oximetry monitoring to detect CHD. A negative screen does not exclude the possibility of congenital heart disease. To help parents more fully understand the screening process, CRMC provides a simple fact sheet that explains the testing procedure and the steps for follow-up testing if a screen is positive.
Even though there are some limitations in pulse oximetry monitoring, the screenings have been proven to provide such a positive impact in the diagnosis of CHD that some states have passed laws to make pulse oximetry testing mandatory. Many others are considering legislation to do the same. Iowa, however, currently does not have any laws in place requiring mandatory pulse oximetry testing for newborns.
CRMC plans to administer the tests indefinitely at this point, even if they do not become mandatory in the state of Iowa. "We just think this is the right thing to do for our young families," said Mohn. "If we can help a single child through this screening process, it will be well worth it!"