Finding Heart Problems in Newborns

Newborn babies have it tough.  They are literally thrust into a world where they must precipitously breath on their own, demand sustenance by whatever means are available to them, and begin that long journey to independence.  Mere moments after they arrive, we start sticking needles into them and otherwise making them aware of many sensations they didn't experience in utero, all in the name of health.  Imagine then, a painless test with a great capacity to detect serious heart problems in new arrivals.  And it's quick, inexpensive, and available at almost any facility that delivers babies.  Rick and I applaud British researchers in this week's podcast for thinking of using pulse oximetry to assess heart health in neonates, as reported in the Lancet.

Pulse oximetry, or PulseOx, as the researchers abbreviate it, is routinely employed in intensive care units to make sure someone's blood is carrying enough oxygen.  A small electronic device is used, usually on a finger in adults or older children, but in newborns on the wrist or ankle, to indirectly measure oxygen saturation.  The device measures the saturation using light absorption in synch with the heartbeat, therefore the term 'pulse' is applied.  Such devices are quite inexpensive and have the distinct advantage of not requiring a needle stick, which for assessing blood gases is no fun for anyone,  especially newborns with tiny body parts.

PulseOx was used in over 20,000 infants in the UK.  Some 53 of these were seen to have major heart defects, with PulseOx achieving a sensitivity of 75%.   False positive results were seen in 169 infants, but since follow-up was relatively benign echocardiography this is perhaps okay.  The authors state that major heart defects often go undetected in this population and that employment of PulseOx will overcome much of this problem, and we agree.  It seems a relatively simple matter of using equipment on hand in a group of patients who may benefit greatly.  Newborns in developed nations already undergo a variety of screening tests from the moment they draw their first breath, beginning with an Apgar score, and followed by blood tests to detect things like phenylketonuria, or PKU.  The idea is that early detection and intervention can prevent a host of problems later.  PulseOx seems like a reasonable addition to the mix.

Here's the issue, of course: while developed countries have the resources to correct or manage major heart defects, of what benefit is detection if the problem can't be fixed, as is the case in developing nations?  For now, the sad conclusion seems to be that using PulseOx is probably not indicated in these circumstances, and indeed, may not even be available.

Other topics this week include use of text messaging to improve adherence to malaria treatment guidelines among healthcare workers in Africa, also in the Lancet, and two from Annals of Internal Medicine:  a disappointing report on the impact of hospitalists and new guidelines for management of COPD, a growing worldwide problem.  Until next week, y'all live well.

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Kristabelle September 4, 2011 at 4:57 am

Didn't know the forum rules alolewd such brilliant posts.


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