Mary Salazar, R.N., advanced practice partner in the UAMS Medical Center's Maternal/Infant Division, uses a pulse oximeter to screen a newborn for congential heart disease.
Feb. 20, 2013 | Three babies born in 2012 at the University of Arkansas for Medical Sciences (UAMS) needed special care; a new screening process for Critical Congenital Heart Disease (CCHD) ensured they got it.
On Jan. 1, 2012, UAMS Medical Center started screening its well-baby population for CCHD, a structural abnormality that causes blood to flow incorrectly through the heart and lungs.
“Prior to being screened, we had no idea there was any issue going on with those three babies and they would have gone home,” said Mary Salazar, R.N., advance practice partner in the Maternal/Infant Division. “Those children didn’t need to have immediate surgery or repair, but all three did need an echocardiogram which did reveal minor heart issues that needed to be followed up post discharge.”
Statistics show that some form of congenital heart disease occurs on average in eight of 1,000 live births.
CCHD leads to decreased oxygen levels in the blood. Some congenital heart diseases can be detected before birth or through physical examination after delivery, but about 30 percent of newborns with a critical congenital heart defect may leave the hospital before being diagnosed.
In October 2011, the American Academy of Pediatrics endorsed the use of pulse oximetry monitoring to detect infants at risk for CCHD in well-infant and intermediate care nurseries.
“We jumped on it very quickly to see how we could implement this in our nurseries,” Salazar said. “We’ve done several teleconferences and communicated to several hospitals in the state about the policies, procedures and protocols so they can implement this process throughout the state.”
At no additional cost to its patients for the screenings, the medical center uses a pulse oximeter, a painless, noninvasive device that can detect the first sign of the most serious heart problems. A nurse or physician uses a small cuff about the size of a Band Aid that is attached to the pulse oximeter. Readings from the cuff on the baby’s hand and foot measure blood oxygen levels.
Salazar said a reading of 95 pecent or above is an indication of good blood oxygenation, a reading of 90-94 percent necessitates further assessment, and anything below 90 percent means the baby is at risk and is transferred to the neonatal intensive care unit for closer monitoring and additional testing.
The test takes about five minutes to perform and costs about $5 per baby for the medical center to do. It’s less expensive than many other tests, and the results are known before the baby goes home.
The medical center screened about 1,900 newborns during 2012, with three newborns requiring follow up.
“If we just catch one child with a serious defect, that early intervention pays for all the other thousand or so,” she said. “It can be such a life-threatening situation that just by screening and detecting it early we can greatly improve their chances.”