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P edia tric s
New Law Requires Noninvasive Test to Detect Life-Threatening
Heart Defects in Newborns
“This test is important because
not all newborns show symptoms
of heart disease right away.”
Critical congenital heart defects (CCHDs)
represent a group of life-threatening heart
malformations requiring intervention within
the first days or weeks after birth. Although
heart abnormalities represent the most common
form of birth defects, prenatal ultrasound
identifies less than half of all cases of CCHD.
Unfortunately, these defects can also be
missed during routine newborn examinations.
In a move to catch more of these defects, a new
California law requires all birthing facilities
to perform a painless, noninvasive pulse
oximetry screening test to evaluate newborns’
blood-oxygen levels prior to discharge from
the hospital.
the readings differ by 3 percent or less. A
reading below 95 percent may indicate the
presence of heart or lung disease, infection or
other problems. Misleading test results (false
positives) are minimized if pulse oximetry is
performed at least 24 hours after birth.
organs,” says Dr. Sklansky. “With early
detection, we can intervene with critical
medications, cardiac catheterization or
open-heart surgery — all of which will not
only save lives but also reduce preventable
morbidity and optimize quality of life.”
“Failing the test does not necessarily mean that
a baby has CCHD, but it does mean that more
testing is required,” says Mark Sklansky, MD,
chief of pediatric cardiology and co-director
of the Fetal Cardiology Program at Mattel
Children’s Hospital UCLA. If other conditions
that would explain the low oxygen level are
not identified, then echocardiography (cardiac
ultrasound) and further cardiac evaluation are
the next steps. Research suggests that pulse
oximetry screening in combination with a
routine physical examination makes it possible
to identify, before hospital discharge, more
than 90 percent of newborns with CCHD.
Many hospitals, including UCLA, already
provide pulse oximetry as a standard of care in
their newborn nurseries. However, California
hospitals are not required to perform the
test in 100 percent of newborns until 2016.
Drs. Sklansky and Smith recommend that
parents request that the test be performed
prior to hospital discharge if the hospital
does not yet do so for all newborns.
“When the diagnosis of CCHDs is delayed,
babies are at increased risk for irreversible
damage to the brain, kidney, heart and other
To watch a video about
screening newborns
for critical congenital
heart defects, go to:
uclahealth.org/ newbornscreening
“This test is important because some forms
of CCHD cannot be detected by a routine
physical exam in the first few days after birth,”
explains UCLA neonatologist Jeffrey Smith,
MD. “A baby with CCHD that is not detected
in the hospital after birth can suddenly
become critically ill at home and may die or
suffer permanent injury before medical help
can be obtained.”
Pulse oximetry, used in conjunction with a
physical examination, is a simple procedure
performed by placing a small probe on the
baby’s right hand and either foot to measure
how much oxygen is being carried in the
blood. The measurement, known as the
oxygen saturation, is expressed as a percentage
of the maximum amount of oxygen that the
blood can carry. A baby passes the screening
test if the oxygen saturation level is 95 percent
or greater in the right hand or a foot, and
Vital Signs Fall 2013 Vol. 60
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