There is a growing movement in the Congenital Heart Defect (CHD) family pushing for the inclusion of testing newborns with a Pulse Oximeter before being released from the hospital. Such a test would provide a fast, inexpensive way to determine if a CHD is present; if the situation warrants, further tests can be conducted.
Back in July I wrote a blog post about an article that appeared in the medical journals Circulation and Pediatrics that stated that Pulse Oximetery should not be supported as a routine test for newborns.
Many readers have misinterpreted that post, the Circulation/Pediatrics articles do not say that the PulseOx test should be discarded, but that more research is needed. (Very few readers click the links in each post, I do not know why. That’s where a lot of extra information about the subject can be found. And sometimes I just might surprise you!)
Seriously, let’s visit the subject of the PulseOx again for a few moments. It’s a pretty good idea – a quick reading of the child’s blood oxygenation level can be determined by a Pulse Oximeter (sometimes called a PulseOx). The test is quick (ten seconds at the most), painless, and inexpensive. Any blood oxygenation level reading below 90% usually triggers a follow-up test: usually an Echocardiogram or an ECG.
While the medical journal article cites its own reason why there needs to be more research into the use of PulseOx, I can see one major flaw they did not mention: A PulseOx test can only detect a Cyanotic Heart Defect. And only about 25% of all heart defects cause Cyanosis.
So what we need, in my opinion, is overlapping tests: PulseOx combined with an Echocardiogram AND an ECG. And perhaps add a Fetal Echocardiogram for mothers who are in high risk groups.
But when you do all that, the CHD test for newborns is no longer fast, and certainly not inexpensive.
And the bad news is that even with overlapping tests, a few CHDs will still slip through. On May 4 of this year I blogged about Nick Heine, the police officer who died of an undiagnosed Congenital Heart Defect while answering a call. Nick had a problem in his heart’s electrical conduction system, and certainly he had undergone a complete physical exam before becoming a police officer. He probably had to have physicals all during his career, but that heart defect never showed itself until the instant it killed him.
So this is where research comes in. Keep looking at the results of the PulseOx; the more we know, the better we can make the test. Research will also make other medical procedures – of all types – better, faster, and less expensive. So perhaps one day there will be one single test, cheap, fast, and reliable, to determine if a child has a Heart Defect.
And until then, we work with what we have – PulseOx.