Thursday, February 10, 2011

Pulse Oximetry

If you have ever been in an emergency room or hospital or even watched too much ER or Grey's Anatomy, you have probably seen a pulse oximeter.  For adults, a little clamp that looks like aligator jaws sits on one of your fingers emitting a red light.  For children and infants, it's usually a sticker wrapped around a thumb or toe.  Like this...

That little red light, which has absolutely no risks or side effects, has the capability of determining the percentage of oxygen in your blood.  It should be at 98-100% in healthy individuals.  Even as low as 94% is perfectly fine.  In a heart with normal structure, the heart pumps blood out to your body.  Your body uses the oxygen in the blood and shoots it back up to your heart, which sends that "blue" or oxygen-poor blood out to your lungs to pick up some fresh oxygen.  Then the oxygen-rich blood is pumped back out by your heart in a lovely, methodical, and beautiful fashion. 

But in most congenital heart defects, blood is not properly routed through the lungs and back out into the body.  That means that in some form or fashion, a CHD heart pumps the "blue" blood out to the body.  Blood without enough oxygen...Keegan's were in the 50% range at birth, and many with repaired hearts walk around with saturations in the 80s.  This happens from the moment a child with a CHD is born and starts breathing.  Recent research has shown that screening all newborns as early as 24 hours after birth can detect over 60% of CHDs and almost all critical congenital heart defects (i.e. those requiring surgical repair within 30 days of life). 

A mere 1/3 of CHDs are diagnosed prenatally (a number which could increase dramatically with proper training for sonographers and OBs).  That means that at least 2/3 are not diagnosed before birth, and over half of those are not diagnosed in routine infant wellness exams.  I know at least 7 children personally who were in that number, and unfortunately, not all of them survived long enough to be diagnosed.  As I mentioned earlier, prenatal diagnosis doesn't guarantee that a child with a heart defect will beat the odds, but for many, it could.

Considering these staggering statistics, it is shocking to me that there are still no national guidelines for pulse oximetry screening and only a handful of states or hospitals that have made it mandatory.  The encouraging thing is that the national Advisory Committee on Heritable Disorders in Newborns and Children has just issued a recommendation that all newborns be screened with pulse oximetry before being released from the hospital after birth.  Of course, that doesn't make it mandatory for states, so a lot of work remains to be done.

Here is a bit more information if you're interested:
http://www.congenitalheartdefects.com/legislation.html
http://1in100.org/category/advocacy/

Amazingly in my research, I discovered that some people are still resistent to mandatory pulse oximetry screening.  They claim that some false positive results will cause "expensive" follow-up echocardiograms for infants that have no heart defect.  They say that the few hundred dollars max are not worth the time and cost for the peace of mind that your child is perfectly healthy.  The Mama Bear in me would like to ball up the bills from Keegan's first month of life (not to mention the last few years; Keegan reached $1 million worth of medical bills in LESS than his first 4 weeks) and stuff them down these people's throats.  But I realize that would be...ahem...counter-productive.  The money saved from even a handful of those lucky children who were diagnosed from mandatory screening would vastly outweigh even 1,000 false positives. 

And if a single echo that turned out to be "unnecessary" saved even ONE CHILD from this...

Then it is most certainly worth it.

5 comments:

Jennifer said...

Great post Maddie! When Sammy was born our pediatrician detected a heart murmur when he was just hours old. Knowing what you were going through with Keegan, the cost of the echo she wanted to do didn't even cross my mind. Turns out his heart was great, and we got the peace of mind we needed. The bill for that was less than $200. Best $200 I have ever spent. It saddens me that some people wouldn't view it that way....

The Coates Family said...

Maddie, because of this post we had the LDR nurse do a Pulse Ox on Cortlandt right after birth. I hate that you have to go through all of this, but thank you for bringing such awareness to this issue. You, Grey, Keegan and the rest of your family are such inspirations of hope, determination and faith. Hugs to you all!!!

BlogToHeal said...

Hey sweetie, I was commenting to tell you that you should really put a watermark on this photo. I see way too many photos like this that are stolen and used in Facebook scams. If you don't know how, I would love to do it for you. My son Corbin passed from heart defects at three months old and I'm very protective of photos. I hope you take this with all the love and care that it is intended with.
Hugs.

Devendra Tiwari said...

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Gurin Products, LLC said...

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