Last week, the Massachusetts state legislature heard testimony in favor of making a new kind of medical screening for newborns mandatory.
Pulse oximetry tests — or “pulse ox” for short — measure oxygen levels and can detect serious heart defects, which are often missed during routine check-ups and are a leading cause of infant mortality. The screening is inexpensive, non-invasive and easy to perform.
Since 2011, the U.S. Department of Health and Human Services has recommended this routine testing. The American Heart Association, the March of Dimes, and the American Academy of Pediatrics concur. This isn’t an unscientific group — pulse ox has been vetted by the most rigorous scientific processes. Several states, such as New Hampshire, Virginia, Arkansas and North Dakota, have made the screening mandatory. The results have been dramatic. Hours after the law was passed in New Jersey, for example, it saved a newborn’s life.
But Massachusetts, a leader in health care innovation, and home to some of the nation’s best health care centers, hasn’t followed suit. Instead, the state Department of Public Health decided earlier this year the screening shouldn’t be mandatory. They reasoned that doctors and hospitals would do the right thing on their own.
But that’s an incorrect assumption. According to a state-sponsored 2012 survey of Massachusetts birthing facilities, only one-quarter were performing the screening, even though the federal recommendation had been out for almost a year.
As a pediatric cardiologist, I have seen first-hand seemingly healthy babies go home, only to become critically ill a few hours or days later and require emergency resuscitation. Many of these cases are entirely preventable.
Traditionally, expecting mothers have prenatal sonograms to look for birth defects. But the quality of these scans varies widely, depending on the skill of the technician and the supervising doctor. In addition, current guidelines supported by the American College of Obstetrics and Gynecology mandate only a limited “four-chamber view” of the heart. As a result, a 1998 study from Southwestern Medical School in Texas reported that many heart defects are missed prenatally. (A quick public health side note: Folic acid can prevent up to 50 percent of many heart defects, but only if taken for about two months prior to conception. Because most pregnancies are unplanned, the Centers for Disease Control recommend that all menstruating women should take a daily multivitamin.)
Unfortunately, when heart defects are missed by prenatal ultrasounds, pediatricians also have a hard time telling if critical cardiac problems are present. Normally, doctors examining newborns suspect heart defects if they hear a loud rushing noise with a stethoscope, notice the child has a bluish color, or lacks a pulse in the lower extremities. But in 1999, British researchers found that half of life-threatening heart defects were missed in routine exams after birth. If the babies with undetected abnormalities were sent home, they often become seriously ill.
That’s where pulse ox comes in. Because no one can tell if babies have a hidden, potentially fatal heart defect, a better method was needed. Taped briefly to a newborn’s foot, a small sensor painlessly beams red light through the foot and measures how much oxygen is in the blood. (Picture E.T. the extra-terrestrial’s finger lighting up, and you get the idea.) It takes about a minute. Of course, as with any screening, the technique still misses some defects, but the proportion is very low.
According to a recent study of 20,000 newborns published in the Lancet, for example, pulse ox found three-quarters of all critical cases of congenital heart defects, and had an extremely low rate of false-positive tests. This only adds to the huge amount of data that pulse ox saves lives. But major public health authorities have already agreed on that.
Now if only all of our birthing facilities and hospitals would get on board. The health of our babies simply can’t wait, which is why a law is necessary.