Thursday, April 9, 2009

Montessori and Baby Health: Screening Babies for Broken Hearts (New York Times online)

A very useful article appeared in the New York Times online edition today. It is called "Screening Babies for Broken Hearts" and is in Tara Parker-Pope's column. Written by pediatric cardiologist Darshak Sanghavi, M.D., it outlines simple steps you can take to have your newborn tested for a life threatening heart problem.

Instead of trying to summarize the medical information, I put the key information below and encourage everyone to read the article in its entirety here.

Recently, researchers have identified a promising new method, called pulse oximetry, to screen all babies for heart defects. Taped briefly to a newborn’s foot, a small sensor painlessly beams red light through the foot and measures how much oxygen is in the blood. It takes about a minute. (Picture E.T. the extra-terrestrial’s finger lighting up, and you get the idea.) If the screening test is abnormal, doctors perform a confirmatory ultrasound of the heart. Last year, Norwegian doctors published one of the largest clinical trials of this strategy, and checked half of all babies born in the country.

The results were impressive. Within a few hours of birth, pulse oximetry detected three-quarters of critical heart defects that had been previously missed. For every 2,000 newborns screened with the toe light, roughly one with a critical heart defect might have been prevented from going home. The cost-benefit ratio compares favorably to current practices of newborn screening for PKU and hypothyroidism. In January, Swedish doctors published an even more methodical study of almost 40,000 newborns, and showed that oximetry entirely eliminated death from missed critical cardiac defects.

Of course, as with any screening, the technique may miss some defects and also involves some unnecessary, though benign, testing of normal children. But these false positive rates were low (only about 1 in 1000 in the Swedish study), and triggered only about two instances of extra, non-invasive testing for every serious heart defect that was picked up. Many parents and doctors caring for children with critical heart defects subscribe to some variant of the “one-percent doctrine.” If there is even a small chance of catastrophe—like the sudden death of a newborn—they feel justified to push for preemptive action, especially when it’s a harmless and inexpensive screening test.

While the screening test is not done routinely in the United States, some hospitals have adopted it, mostly in Texas and Florida, where some small trials have been conducted. But parents can ask doctors to screen their babies for heart defects using pulse oximetry. It’s essentially free since it needs no specialized equipment other than the oximeter, which is present in every hospital already. A specialized doctor isn’t needed; the test is quite simple, and a nurse can do it if the pediatrician orders it anytime after birth, but before discharge from the hospital. Hopefully they won’t mind doing it. Personally, I do think parents should request it. I did for my kids.

Another great article in Parker-Pope's on Health column!

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