New test at Midtown Medical helps save babies

lgierer@ledger-enquirer.comJanuary 20, 2014 

A new test allows doctors at Midtown Medical Center to detect critical congenital heart defects in newborns that might otherwise go unnoticed.

The hospital began screening infants using pulse oximetry at the beginning of the year.

Dr. David Levine, in his third year as director of newborn services for Columbus Regional Health, said the defects, if not quickly diagnosed and properly managed, are often lethal.

"The baby can look perfectly healthy," Levine said. "The doctors can listen to the heart and not hear anything unusual."

Newborns are given a blood test which covers more than 20 possible health problems, including sickle cell and cystic fibrosis. Levine said certain heart defects will not be found.

The hospital also checks hearing.

Using pulse oximetry for newborns is relatively new and is still not found in many hospitals.

The pulse oximetry determines if there is adequate oxygen in the baby's blood stream and checks the baby's pulse rate.

A low level of oxygen in the blood can be a sign of a critical congenital heart defect but does not confirm that.

If a test comes up positive, other tests such as an echocardiogram must be done.

Not every hospital has someone capable of performing a pediatric echocardiogram, but Midtown does in pediatric cardiologist Edward Bayne.

Levine said nationally about 18 of 10,000 babies have a critical congenital heart defect that if undetected can be deadly. Levine said the number is not great but "every life is important."

"There are a number of heart problems that can be identified with this new screening. One of the most important is hypoplastic left heart syndrome," Bayne said."

"This is a complete underdevelopment of the left side of the heart … . This used to be a lethal problem, and over the last 25 years we've been able to fix HLHS with surgery. So we want to catch this defect early and fix it. All of the problems that can be identified with this screening are potentially lethal, so that's why this is so important."

In the procedure, a band with sensors is put on the child's palm or wrist along with one on the ankle to make sure readings are consistent.

A light source is sent through capillaries and the amount of oxygen is determined from returning light.

Oxygenated hemoglobin absorbs light differently from non-oxygenated hemoglobin.

Sumer Buckner, director of family center care at the hospital, said the test can be done in the nursery or in the mother's room.

"We can just do it anywhere," Buckner said.

She said the screening is done by trained nurses within 24-48 hours of birth and only takes about five minutes.

It is painless, and no needles are involved.

Buckner said if a positive reading comes back indicating there might be a problem, the child is re-tested about an hour later.

Dawn Hurst, the hospital's senior director for women's services, said the test is inexpensive and to give every baby an echocardiogram would cost much more.

She said she is "very proud" of the work the nurses do.

"We want the parents to have all the information about their child that is possible," Hurst said,

Columbus Regional Health's Chief of Pediatrics Dr. Joseph Zanga said the test is something each hospital needs to give.

"Pediatricians have been looking for something like this for a long time," Zanga said. "It is another great tool."

"We might only have one child with defect we would find with this test but it is worth it. Every child is important," he said.

He said the test must be done

properly. Zanga said without this test the baby may leave the hospital with the doctor thinking everything is fine.

Zanga said before beginning to give the screening at Midtown, it was studied by Bayne for more than year.

He studied material and talked to people, Zanga said.

"We wanted to make sure of it," Zanga said, "About six months ago, Dr. Bayne told us, the science is there. This not just a fad. This is good science and we can save the lives of babies."

Bayne is associated with the Sibley Heart Center, which specializes in caring for children with congenital heart defects and has physicians in 19 locations across Georgia.

"Two of my colleagues were instrumental in the whole process," Bayne said. "One set up the guidelines that are now used for screening, and the other came up with a computer application that applies time, ages and oxygen levels to create the pass/fail reading."

"The whole thing is really very important. My part, at the local level, will be to be notified if there is a positive test," Bayne said. "Then I will do an echocardiogram to see if we really are dealing with a congenital heart defect. The problem is these babies with the serious conditions eventually go home from the hospital with no symptoms and end up in the emergency room. So it's important to identify them early."

He said if a baby has a congenital heart issue, symptoms could show up anywhere from a few days to the end of the first month.

"The baby may have shortness of breath and blue discolorations and then go into shock. So if we miss that, we're behind the eight ball," Bayne said.

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