Newborn Screening for Critical Congenital Heart Disease (CCHD) Written By: ViviAnne Fischer, MA, CPM, LM
Pulse oximetry screening is close to my heart. I had a good friend give birth to a seemingly healthy baby boy 4 years ago at a birth center with midwives. In the first week after the birth, she felt something was wrong- she thought he was too sleepy, sometimes he panted when breathing and she had a hard time feeding him. Her midwife and pediatrician said everything was within normal and weren’t concerned, after all he was gaining more weight than expected (can you guess why?). Finally at two weeks she made an appointment with another pediatrician, after expressing her concerns the pediatrician, said “show me”, those were the words that she feels helped save her son. The pediatrician observed and then screened her baby with a pulse oximeter- there was no reading in the foot, she tried several other pulse oximeters thinking they must be defective, and she then told her to go straight to a children’s hospital. At the children’s hospital they learned her baby was born with a Coarctation of the Aorta- after many days of the heart working so hard it was on the verge of failing.
1 in 100 babies are born with a heart defect, he joined those statistics that day. One of the best neonatal heart surgeons in the country performed his surgery, his heart was so strained that he went into cardiac arrest during the surgery and was on full life support (ECMO) for a week- the statistics for survival were dim and doctors told her he was hanging onto life minute by minute. Miraculously, he lived and is now thriving.
If her midwife or pediatrician had screened her very normal and healthy looking baby with a pulse oximeter earlier, the surgery and the weeks after would have likely been more straightforward and less life threatening. She feels very blessed he lived, as many other babies in his situation don’t make it.
Some midwives feel paying $500 for a neonatal pulse oximeter is too expensive. My friend’s midwife said “I will likely never see it again”. Actually, as midwives we WILL likely all see a congenital heart defect, 1 in 100 is not rare- it will happen and physical examination of a newborn is only 50% effective at detecting CHD. I think we all need to consider how we would feel if we did not give our clients full informed consent regarding CCHD screening and they lost a baby because we either didn’t purchase a pulse oximeter and go through training or refer them to a physician.
Here are some good things to know about CCHD screening with pulse oximetry:
†You need to invest in a neonatal pulse oximeter. The Massimo Rad 5 is great! Some Pulse Oximeters on the market for infants and children are not adequate to screen for CCHD. You need an FDA pulse oximeter approved for neonates.
†Trainings are readily available through CCHD screening programs, free, and take about 2 hours. Contact me at firstname.lastname@example.org and I can help you find a cardiac care coordinator happy to train midwives!
†Download the Children’s Healthcare of Atlanta “Pulse ox tool” on your phone, you can input the results of your readings to determine if the newborn passes the screen or not. A passing pulse ox sat is greater than or equal to 95% in either extremity AND a difference of less than or equal to 3% between the right hand and a foot.
†Screening typically takes less than 5 minutes and is non-invasive. pg. 9
†The screening needs to be done at least 24 hours after the baby is born, optimally between 24- 48 hours.
†If the newborn’s saturation is less than 90% in either the hand or foot, he/she should be immediately referred for additional evaluation.
†If the oxygen saturations are less than 95% in both the hand and foot or there is greater than 3% difference between the two on three attempts to screen each separated by one hour, the newborn should be referred for additional evaluation. The Pulse Ox Tool automatically calculates this for you!
†It is possible that a baby with CHD can have a normal pulse ox reading, however, many forms of CHD can be caught early with pulse oximetry screening.
†If you choose not to screen, you are still obligated to give your clients full informed consent about the CCHD screen and refer them to their pediatrician.