Another look at Pulse Oximetery

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.


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10 Responses to “Another look at Pulse Oximetery”

  1. Ellinger Family Says:

    We were not prediagnosed with Nathan about his heart defect. When he was born he was grunting but wasn’t blue. The pulse ox was used, which led to a cpap, which led to an x-ray, and then to the echo that determined Nathan’s problems. I whole-heartedly believe it should be a routine thing because its cheap, non-invasive, and just as easy as listening for a murmer.

    • Steve Says:

      In your situation it worked, and I am very glad it did. But what if it had been one of the CHDs that are not normally detectable by PulseOx?

      You missed the point of this post. The point is that you continue the research to find a newer, better method. Until then, you use all the tools at your disposal – and that includes a PulseOx test.

  2. Lisa Says:

    I’m definitely a fan of the pulse ox! If they had checked Clint’s O2 at 24 hours, we would not have been in an emergency situation at 48 hours.

    I think it’s definitely better to catch some CHD than none. Someday, hopefully in the not too distant future, a shift will be made in the right direction.

    • Steve Says:

      I agree. The test is important… but we need for it to be better. That’s why research (in all fields) needs to continue. Perhaps the PulseOx isn’t the answer; perhaps a defective heart produces more/less/different enzymes that are detectable through a simple blood test. That’s why you keep looking!

  3. Ellinger Family Says:

    I agree that it would be nice if in the close future that someone could come up with a more routine test that could catch all CHD’s. I was putting it from that standpoint though that we need to use what we have available until something better and more reliable comes along. We are lucky that it worked for us.

  4. Kim McGee Says:

    My husband and I agree that screening for heart defects should become a part of routine newborn screening. We did not have a prenatal diagnosis for our son’s TOF. Unfortunately, a pulse ox alone would not have been enough to trigger further tests as he consistently had saturations of over 95% until his repair at 7 months. Thankfully, due to his premature birth, he was in the NICU and a nurse finally caught on that he had a very loud murmur and a echo was ordered.

    After reflecting on your post, I now realize that a required echo and/or ECG as part of newborn screening might be cost prohibitive but also realize that a pulse ox alone might be enough. Here in NC, screening for CF recently became a mandatory part of newborn screening. Would you recommend lobbying state legislatures to add the current and reliable tests (echo, ECG, pulse ox) while continuing to search for even better methods for diagnosing CHDs?

    • Steve Says:

      I was thinking more on the Federal Level. Earlier this year I was in DC helping lobby for the Congenital Heart Futures Act, which has been introduced into both Houses of Congress with multiple sponsors (of both parties) for each bill. (Search the Funky Heart Archives for Congenital Heart Futures Act)

      Unfortunately, both bills are stuck in Committee as all attention has been turned to the Health Care Debate. We’re planning to return to DC for more lobbying efforts in April, by then Health Care will be decided – for better or for worse – and we’ll know what we need to do to try to get the bills moved along.

      Also there is no provision in the Congenital Heart Futures Act for screening. We can overcome this in two ways: 1) Withdraw the bill, add the language needed, and resubmit. That will be difficult. 2) Get the bill passed and signed into law, then when it is time to fund the Act, get “Report Language” to allocate the funds to create a screening program. Report Language is Congress-Talk for “suggesting” uses for funding. In other words, Congress would send the National Institutes of Health a letter that says “We’re giving you XXX million dollars to fund the provisions of the Congenital Heart Futures Act this year. We think you should use two million of that amount to create a national screening test for CHD.” The NIH, wanting to stay on Congress’ good side (since they control funding) almost always follows their “suggestions.”

      All bills that have not died in committee, by vote, or been vetoed “die” when Congress holds mid-term elections. If the Act is still in committee and expires in this way, it can be introduced again, this time with the screening requirements.

  5. Melissa Says:

    My local hospital has recently started a program to PulseOx screen all babies before there before discharge. Sure, a lot of defects will slip through the cracks, but in the first year of the hospital’s program, they detected a few cases of CHD that would have been missed.

    I totally agree with your conclusion. No, it’s not a perfect test, but it’s what we’ve got as a non-invasive, cost-effective test to catch what can sometimes be the worst of defects.

  6. Leighann Says:

    I like Jack’s tongue. 😉

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