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Vincent Iannelli, M.D.

Screening for Congenital Heart Disease

By August 22, 2011

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Many babies are found to have congenital heart defects when they become "blue" or have low oxygen levels, have trouble breathing, or because a doctor or nurse hears a heart murmur.

Unfortunately, those methods aren't very specific, and it is possible that babies can leave the nursery and go home before their congenital heart disease is discovered simply because of the way the circulatory system works in a newborn. When a baby is born, remnants of the fetal circulation system can continue working, masking some of the signs and symptoms of critical congenital heart disease.

New recommendations for newborn screening for critical congenital heart disease will hopefully mean that all babies get diagnosed as early as possible. This new recommendation, outlined in a report that will be published in the November issue of Pediatrics, "Strategies for Implementing Screening for Critical Congenital Heart Disease," will be that all babies should be screened "for low blood oxygen saturation through the use of pulse oximtery monitoring to detect CCHD in well-baby and intermediate-care nurseries."

Of course it won't detect all heart problems, but it should identify those that are associated with low oxygen levels, including:

  • hypoplastic left heart syndrome
  • pulmonary atresia
  • tetralogy of Fallot
  • total anomalous pulmonary venous return
  • transposition of the great arteries
  • tricuspid atresia
  • truncus arteriosus

Babies will be screened before they are discharged from the nursery, preferably when they are 24 to 48 hours old, or as close to discharge as possible if they are going home before 24 hours.

A negative screen (no sign of critical congenital heart disease) will include a pulse ox reading of greater than or equal to 95% in a newborn's right hand or either food and a difference in pulse ox readings between the right hand and foot that is less than or equal to 3%.

A positive screen will likely mean other tests, like an echocardiogram.

This new recommendation is endorsed by the American Academy of Pediatrics, the American College of Cardiology Foundation and the American Heart Association and is already being done voluntarily at some hospitals.

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