Baby Talk: Early screenings help detect congenital heart disease

October 8, 2013 

Q: What kinds of tests are routinely done on babies before they leave the hospital?

A: Since the 1960s we have been testing babies for the metabolic disorder called PKU. It was found that if we tested every baby we could bring down the cost of the test. It was worth testing every baby to find that one baby that would have died or suffered brain damage if we only knew the baby had that disorder. Since then we have added more than 30 tests by using five drops of blood.

In the late 1990s, a hearing screening was added to the routine testing on babies before they left the hospital. If a baby does not pass the screening they are then referred for further testing.

One of the latest routine tests that we do on babies before they are discharged is called CCHD, Critical Congenital Heart Disease. Congenital heart disease is one of the most common groups of birth defects. CCHDs are structural heart defects that can often be corrected with early intervention, usually surgery.

The Center for Disease Control estimates that in the United States, about 1 in every 100 babies is born with a congenital heart defect. It is believed to be the most common cause of death of an infant in the first year of life. The earlier it is detected, the sooner it may be corrected.

CCHD is very tricky. Many babies that have CCHD look normal until they are around 10 days old. They then die suddenly. Their little hearts no longer can compensate and stop working.

How the test is done is simple. We put a pulse oximeter on the baby's right hand and one of either foot. A pulse oximeter measures the percentage of hemoglobin (an iron containing pigment that carries oxygen from the lungs to the tissues) in the blood that is saturated with oxygen. The baby needs to be in a quiet state and more than 24 hours old. If the baby does not pass the initial screen a second one is done an hour later. If the oxygen saturation is below 90 percent in either the hand or foot, the baby is immediately assessed and the medical provider is notified. If the infant fails the screen, the baby assessed, the medical provider notified and an echocardiogram is done.

Please keep in mind it is the combination of mother's observing their babies, nurses trained to assess babies, the trained medical provider's assessment, as well as the testing that is done that identifies babies that are at risk. If you notice color changes, excessive unexplained irritability, sweating that increases with feeding, poor weight gain, decreased activity or excessive sleeping or a delay in motor milestones, these all are sign that trouble may be brewing.

The Florida Senate passed mandated CCHD testing in December 2012 and the House of Representatives followed in January.

For more information you can go www.cdc.gov/Features/heartdefectsawareness/ and view "A Mother's Story." The story is moving. You will understand and be grateful that we are now doing this screening on all babies.

Katie Powers, R.N., is a board-certified lactation consultant and perinatal educator at Manatee Memorial Hospital's Family BirthPlace. Her column appears every other week in Healthy Living..

Contact her at katie.powers@mmhhs.com.

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