Posts Tagged ‘Newborn’

Another look at Pulse Oximetery

December 2, 2009

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.

Pulse Oximemetry: Not Recommended

July 13, 2009

A new scientific statement from the American Heart Association and American Academy of Pediatrics will not recommend using Pulse Oximetery to screen for Congenital Heart Defects (CHDs).

Despite repeated pleas from the CHD community (including a post on the Funky Heart blog) the authors of the scientific statement feel there are too many variables that can affect the test. They are not saying that the test should be abandoned completely; in fact they encourage facilities that are already performing the test to continue – and to compare results.

Pulse Oximetery is a simple, painless test that can be used to detect the presence of a Congenital Heart Defect in a newborn infant – but is it too simple? The Pulse Oximeter can detect low levels of oxygen in the blood, which is called Cyanosis and is a recognized sign of a complex heart defect. But only 25% of heart defects cause Cyanosis. And as simple as it is, the Oximeter can be misused.

If you want an accurate test, you have to standardize the the testing procedure. A child born in a hospital in Denver will naturally have a slightly lower PulseOx reading than a child born in Washington, DC – would we have to have a “Normalized PulseOx reading” for different sections of the country?

What we need is more statistical information about the accuracy of Pulse Oximeter testing, and perhaps an even better screening test. A test that is just as fast and just as inexpensive.

That’s one of the reasons that ongoing CHD research is so important.