By Marie McCullough, The Philadelphia Inquirer
7:55 PM EDT, August 14, 2013
At birth, Moriah Mudd seemed strong and healthy. Her physical exam by a pediatrician at Riddle Hospital in Philadelphia was completely normal.
But then a nurse put a sensor on her foot and, within minutes, a machine called a pulse oximeter revealed that her blood oxygen level was alarmingly low, a sign that something could be critically wrong with her heart.
Three weeks later, Moriah underwent surgery at Alfred I. duPont Hospital for Children in Wilmington, Del., to correct a severe congenital heart defect diagnosed by follow-up tests.
Had it gone undetected, she would have gone into respiratory distress at home in Sicklerville, N.J., said her mother, who is a family physician.
"She's doing great now," Kimberly Jones-Mudd said of her daughter. "She's growing, eating, and her heart looks good."
Pulse oximetry screening for congenital heart disease has become standard practice across the country, less than two years after New Jersey became the first state to require it, surveys show. Even in states such as Pennsylvania and Delaware that do not mandate it, the simple, noninvasive, few-dollar test is done in almost all birthing hospitals, surveys show.
It's too soon to know the impact of screening, but anecdotal cases like Moriah's and early reports are all good. In New Jersey, hospitals identified two newborns with critical congenital heart defects out of more than 25,000 babies tested in the first three months after universal pulse oximetry screening began in August 2011, according to the Centers for Disease Control and Prevention. The CDC review also found that 10 infants with positive screens turned out not to have heart defects, a false alarm rate lower than in large European studies.
"It's a highly useful test. It's both cost-effective and life-saving," said Samuel Gidding, head of cardiology at duPont Hospital for Children.
"It's a screening program that people are embracing. They realize they should be doing this as part of good medical care," said Pittsburgh neonatologist Robert Cicco, vice chair of a committee that helps the Pennsylvania Department of Health develop newborn-screening guidelines.
In Europe, studies show that about 1 in 4 newborns with positive pulse oximetry screens — that is, blood oxygen saturation below 95 percent — have a heart defect that could cause disability or death. Lung problems are also sometimes detected through positive screens.
In 2011, following advice from leading medical groups, the U.S. secretary of Health and Human Services recommended that pulse oximetry be added to the uniform screening panel for newborns.
Since then, all but four states have added screening laws, rules or pilot programs, according to the Newborn Coalition, an advocacy group. Even in the four states without formal initiatives, most hospitals screen.
Prevalence of heart problems
Of the 40,000 babies born with congenital heart problems each year in the U.S., about 10,000 have a defect so severe they need corrective surgery or other procedures in infancy, research shows. Many of these defects show up on fetal ultrasound. But experts estimate as many as 200 babies a year die from critical defects that go undetected until too late.
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