Universal Heart Screening Recommended for Newborns

A new study recommends low-cost test for heart defects.

May 1, 2012— -- All newborns should undergo a standard screening for life-threatening heart defects, according to new recommendations published in the Lancet.

Researchers suggested that a pulse oximetry, a low-cost, non-invasive device that tests patients' blood oxygen levels, is more accurate at detecting such heart conditions than a standard clinical examination, and it should be used internationally as routine assessment in all newborns before they leave the hospital.

"The findings of this meta-analysis provide compelling evidence for introduction of pulse oximetry as a screening method in clinical practice," Dr. Shakila Thangaratinam, lead author of the study, wrote in a statement. "The sensitivity of the test is higher than present strategies based on antenatal screening and clinical examination, and the false-positive rate is very low, especially when done after 24 hours of birth."

The device showed an accuracy rate of 99.9 percent, and detected 76.5 percent of all congenital heart-defect cases and had a low false-positive rate of .14 percent. The findings were based on 13 studies that included nearly 230,000 newborn babies.

Congenital heart defects, or flaws in the structure of the heart and blood vessels, are the leading cause of death in newborns, but outcomes can drastically differ if the condition is found early and babies have corrective surgery quickly. The test is intended to detect critical congenital heart disease, not minor heart defects such as heart murmurs.

Since 2011, four states in the United States have passed laws that require newborns to undergo the basic test.

"I agree with the recommendations to use the low-cost screening test of pulse oximetry to help diagnose newborns with congenital heart disease," said Dr. Dennis Mello, director of pediatric cardiac surgery at Ochsner Medical Center in New Orleans. "Pulse oximetry, however, will not detect all patients with congenital heart defects. The cost of pulse oximetry is low and its use could be easily implemented in clinical practice."

Each test averages about $5 to $7 per baby, said Dr. Terry Anderson, a pediatric cardiologist at The Children's Hospital of Philadelphia who is a proponent of the screening.

Anderson helped to implement the screening for all babies born in the state of New Jersey, the first state to pass legislation mandating the test.

"Since it went into effect in August, 2011, we've screened about 50,000 to 60,000 babies," said Anderson. "These babies are ready to go home and look healthy and nice and pink, but then they have this underlying condition and these are the babies that collapse or go into shock and potentially die, so detecting these babies right upon birth is certainly beneficial."

Since New Jersey enacted its legislation, Indiana, Maryland and Virginia have followed suit, Anderson said. Most other states have legislative proposals in the works.

Anderson said some experts argued that false-positives will cause unneeded stress for families and the tests will add extra costs to a health care system that has an already strained budget. But Anderson argued that the detection of severe heart disease in a baby before leaving the hospital eliminates other extreme costs, like emergency room visits and expensive surgical repair.

While nearly all U.S. hospitals already have the need testing equipment, many around the world are stretched for resources. Anderson said it is worth investing in the inexpensive device because of the potential lives saved and high costs avoided.

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