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New law requiring screening for heart disease provides effective protection for newborns, says Staten Island pediatrician

silive.com

Kathryn Carse/Staten Island Advance By Kathryn Carse/Staten Island Advance
on August 19, 2013 at 4:10 PM, updated August 19, 2013 at 5:08 PM
BABYLEGS hl NEWBORN19.jpg It is estimated that at least 280 infants are discharged from the hospital each year nationwide with unrecognized critical congenital heart disease.PRNewsFoto

STATEN ISLAND, N.Y. -- Listening for a heart murmur is one way a doctor monitors a child's cardiac health. However, at birth, a simple and inexpensive test can be done to detect a heart problem that may not be observable.

Known as pulse oximetry, the technology determines the percent of oxygen saturation in an infant's blood. Low levels of oxygen can be a sign of critical congenital heart disease (CCHD).

Governor Andrew Cuomo recently signed into law the requirement that all New York hospitals and birthing centers screen every newborn for CCHD.

Defined as a problem with the heart's structure and/or function present at birth, congenital heart disease is the number one cause of infant deaths from birth defects. It is estimated that at least 280 infants are discharged from the hospital each year nationwide with unrecognized CCHD.

Testing at birth will enable early diagnosis and lifesaving interventions to be performed before the infant is discharged.

The test was already routine in many New York hospitals such as Staten Island University Hospital where it has been done for the last 10 years, according to Dr. Philip Roth, director of neonatology.

In those years, CCHD has been detected in two or three babies. However, with prenatal care and a pediatric cardiology unit, the hospital diagnoses cardio-vascular problems in many more babies, said Dr. Roth.

The test is particularly helpful, he said, in catching the oxygen levels in a newborn that may not be low enough to cause an observable symptom, such as turning blue, but does indicate a problem that will develop, often after the baby leaves the hospital.

The price tag of $5 to $10 dollars to administer the test, he said, is well worth it. The treatment for a child returning to the hospital in cardio-vascular collapse would cost 2,000 times that amount, and the child may suffer brain and organ damage.

New York state's newborn screening program was established in 1965 and screens 250,000 babies a year for 45 separate diseases each year such as sickle cell anemia, cystic fibrosis, HIV, and congenital hypothyroidism.

CCHD screening is required in 29 states through either legislation or regulation, a number has changed almost daily as more states have begun to require the screening. The March of Dimes and the American Heart Association raises awareness about and lobbies for this simple and inexpensive test.

"Since March of Dimes grantee Dr. Robert Guthrie's development of the first newborn screening for phenylketonuria (PKU) in Buffalo 50 years ago, New York State has been a pioneer and leader in newborn screening," said Dr. Jennifer L. Howse, March of Dimes President. "Passage of this law is a fitting tribute to the March of Dimes 75th anniversary."

The pulse oximetry is one of two non-blood test — the other is hearing — for newborns.

All the tests, said Dr. Roth, "can help head off a disaster that could affect 70 to 80 more years of a person's life."

In addition, he said, the database that will result from the new state requirement will provide useful information in testing and treating heart disease in newborns.

Dr. Roth is both chairman of the pediatrics department and vice president of medical education.

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