Running head: THE PULSE OXIMETRY TEST
Pulse Oximetry Test- Saving Infants with Critical Congenital Heart Defects
Megan Tolton
First Colonial High School
LSA Research & Writing
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Abstract
This paper is about the pulse oximetry test and its need to be passed into legislation in all
states. This test has been passed in several states already but there are seventeen states that still
need to pass and introduce this legislation. Virginia is the only state that has implemented an
executive order for this test. The pulse oximetry test is used to help detect critical congenital
heart defects in babies when they are born. It allows doctors to treat the defect as fast as possible
without harming the baby in any way. It has been a popular test among many parents who have
benefited greatly from this test and saved their baby from dying. The pulse oximetry test can
allow parents to be relaxed when their baby goes home for the first time.
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Pulse Oximetry Test- Saving Infants with Critical Congenital Heart Defects
What is the Pulse Oximetry Test?
What It Measures
Every year newborns are delivered in hospitals around the United States. Many of them
healthy yet 8 in every 1000 babies will be diagnosed with a congenital heart defect (Frequently
Asked Questions- Children’s National). Over 4.2 million babies are born each year in the United
States, and congenital heart defects are the most common defect in a newborn (U.S. Health &
Human Services & Critical Congenital Heart Defects). Congenital heart defects cause infants
hearts to look different. Many infants are able to grow and function normally with a congenital
heart defect (Frequently Asked Questions- Children’s National). However, critical congenital
heart defects need to be treated immediately and can cause death in infants if not treated fast
enough. 18 newborns for every 10,000 births will be diagnosed with a form of a critical
congenital heart defect (Pulse Ox Screening for CCHDs, 2012). One test known as the pulse
oximetry test helps to measure the level of oxygen in the baby’s blood, to help detect a possible
critical heart defect. A low level of oxygen in the blood could mean a critical congenital heart
defect (O’Dowd, 2013). The test helps prevent a family from taking their baby home and then
seeing their baby turn blue from lack of oxygen, and then dying. Many families have
encountered this horrific sight, but the pulse oximetry test can tell doctors to treat the issue
immediately. The pulse oximetry test provides a noninvasive yet affordable screening that can
save a baby’s innocent life from dying of a critical congenital heart defect.
The Invention
The pulse oximetry test was first created in the 1970s, but now it has become a widely
used test (Children’s National, 2013). The echocardiogram is needed in detecting a heart defect,
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and is paired with the pulse oximetry test. If the test comes out positive for a critical congenital
heart defect, the echocardiogram helps in identifying the type of critical congenital heart defect.
Many rural hospitals however, don’t have access to equipment such as the echocardiogram due
to its cost, preventing many hospitals from using the pulse oximetry test. The lack of pediatric
cardiologists is also an issue in many rural hospitals (Roan, 2011).
The 7 Deadly Heart Defects
The pulse oximetry test was created to detect seven critical congenital heart defects
which are known as the hypoplastic left heart syndrome, pulmonary atresia (with intact septum),
tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries,
tricuspid atresia, and truncus arteriosus (Pulse Oximetry Screening for CCHDs, 2012).These are
critical and many infants that are diagnosed with a critical congenital heart defect will eventually
need a heart transplant.
The Screening Process
The pulse oximetry is a quick and painless test that can be done for a newborn. The
process for the test is very simple and quick and done after the first 24 hours of life for the baby.
According to Johns Hopkins Health Library, a clip looking device is placed on the baby’s finger
or toe. This test measures the blood and oxygen saturation levels. The doctors are then able to
evaluate the levels of oxygen needed for the baby after seeing the amount of oxygen in the blood.
According to the CDC, the test takes around 10 minutes to complete. Many families face the
possibility of their child testing positive for a critical congenital heart defect. This test is able to
reassure families that although their baby may have something wrong with their heart, doctors
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will be able to correct the problem or be able to transfer the baby to a major medical center that
specializes in pediatric cardiology.
Implementing Pulse Oximetry Legislation
Parents Support for Legislation
Parents are the main reason that this test has been introduced into legislation. Stories of
hope and tragedy have caused state legislators to rethink the idea of vetoing the legislation,
which happened in Virginia. Statistics have also come into play. As mentioned before, statistics
have shown that 8 in every 1000 babies are born with a congenital heart defect (Frequently
Asked Questions- Children’s National). Also congenital heart defects are the most common
types of birth defects in babies. 1 in around 6 babies who are undiagnosed for congenital heart
defects will die unfortunately (Roan, 2011). And that one child out of every six children most
likely had a critical congenital heart defect. According to Los Angeles Times writer Shari Roan,
around 2,000 more babies could be diagnosed, if the pulse oximetry was implemented into
legislation. However, seventeen states have yet to pass the legislation making it a requirement
that all hospitals conduct the pulse oximetry test on every newborn after its first 24 hours of life
(Fox, 2013).
Rural Areas Fight for Legislation
Many parents must research ahead of time to figure out if the hospital they are planning
on going to has the pulse oximetry test when they deliver their baby. States with major medical
centers most likely have this test, but states with mainly rural areas, such as Montana, are less
likely to have the test. Montana has yet to pass this test. The echocardiogram is expensive to
purchase. But the echocardiogram is needed to identify any heart defects in the baby along with
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the pulse oximetry test. Even if these rural hospitals have the pulse oximetry test, they are often
worried about their financial status. They worry that if they come across a baby with a critical
congenital heart defect that has a false positive, and they send it to a major medical center,
they’ll be losing money due to the unnecessary transfer of the infant.
Many pulse oximetry test advocates are trying to spread the implementation throughout
the Midwest. The Midwest, of course, has many rural hospitals that lack the funding to afford
certain equipment and don’t provide all the services. Advocates claim that if it spread even
further throughout the Midwest, over 90 percent of critical congenital heart defects would be
detected eliminating the possibility of death in newborns. Some of these Midwestern states
include Illinois, Wisconsin, and Iowa. The American Heart Association has been working
closely and diligently with these states and the states legislators in order to devise a plan to
implement the pulse oximetry in all of the state’s hospitals. Wisconsin pulse oximetry legislation
was introduced in March (American Heart Association Focuses on Newborn Screenings, 2013).
First States Legislation
New Jersey was one of the first states to pass this legislation (O’Dowd, 2013). It passed
into legislation in earlier part of 2011. The state legislators made it so that all birthing facilities in
New Jersey offer this test and it is mandatory for all babies to receive the test after the first 24
hours of life. This eliminates the pressure of the ultrasound screening to detect the critical
congenital heart defects, in which they were only detecting half of the critical heart defects in
infants. When the child receives an abnormal reading, they are retested to confirm the diagnoses
(Kasprak, 2011). Less than two years after legislation into its first state, the pulse oximetry test
has become a widely practiced test (McCullough, 2013).
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Virginia Legislator
Vetoed By Governor McDonnell
The legislation in Virginia was originally vetoed by Governor McDonnell, but many
parents rallied for him to rethink his decision. Around 4 out of every 1000 babies are born with a
critical heart defect in Virginia. And around 300 babies are diagnosed with one every year in
Virginia. Only 74 percent of babies are currently diagnosed at birth (Governor McDonnell Signs
Executive Directive 4, 2012). Children’s National voiced their opinion when Governor
McDonnell vetoed the original legislation. They believed that the veto hurt their chances of
getting $1 million in federal funding to help with critical congenital heart defects for newborns.
They were perplexed why the American Academy of Pediatrics, American College of
Cardiology, the American Heart Association, and the U.S. Department of Health and Human and
Human Services all supported this test, yet Governor McDonnell chose to put this legislation
aside for another time (Children’s National Disappointed in Gov. Bob McDonnell, 2012).
An Executive Order
Governor McDonnell later implemented the executive order. "An Executive Order would
put the critical congenital heart disease screening policy in place without creating any new
government bodies or increasing the size of government,” according to Dr. Robert Shor, a
cardiologist from Northern Virginia. The executive order has no effect on the budget, which was
ideal for Governor McDonnell (VA Governor Signs Executive Order for CHD Screening). The
executive order would create a workgroup which will work on a program to screen babies for
critical heart defects. This workgroup would be working closely with the Virginia Department of
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Health. They would also be working on an early intervention program which would help babies
who are diagnosed with a critical congenital heart defect.
Pros & Cons of the Pulse Oximetry Test
The Pros
The pros of the pulse oximetry test outweigh the cons. It is easier for a parent to
experience coming to terms with their child having a critical congenital heart defect within the
first 48 hours than having to find out that their child is turning blue at home because they have a
critical heart defect. The test allows doctors to figure out what to do very early in the process.
The pulse oximetry test can identify a total of 7 critical congenital heart defects (Screening for
CCHDs, 2013). Prenatal ultrasounds before the pulse oximetry test became popular only helped
to identify half of all congenital heart defects, which let many babies go home (Downing,
Garlick, 2013). The pulse oximetry is cost effective and more accurate.
The Cons
Many parents worry that the test will give their baby a false positive. There have been
false positives, but that’s only .14% of the cases. A way to keep false positives low is to make
sure that the infant is alert according to the CDC. Doctors will check the baby in order to see
why the baby didn’t pass the test (Indiana Department of Health). Unfortunately, this test doesn’t
detect all forms of critical congenital defects and babies can test negative for a congenital heart
defect when they have one of the rare forms that the test doesn’t detect.
Parents are allowed to object to the test only for religious reasons, however. In order to
claim that their religion is against the pulse oximetry test, the parents must submit the state’s
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religious waiver form or the hospital’s form in order to not allow their child to participate in the
test. No other reasons will be reviewed to why the parent doesn’t want the test for their newborn
(Indiana Department of Health).
Families Affected Positively By This Test
Many families come to terms with the idea that having a baby look healthy doesn’t mean
the baby is actually healthy. Parents are relying heavily on newborn tests because of the
numerous rare disorders babies have been diagnosed with. Only recently has the pulse oximetry
test become widely popular. Although parents have seen their newborns go through numerous
surgeries because the pulse oximetry test detected the heart defect early in their newborn, it
allows them to relax and know that their child is in good hands and being treated. Without some
states implementation of the law, many newborns would pass away.
Family from Connecticut
One family from Connecticut benefited greatly from this test. Their baby was born in
July, and their baby looked completely healthy. They were getting ready to take the infant home,
when a cardiologist came and told the parents that they would have to transfer the baby to New
York Presbyterian Hospital for heart surgery. Their newborn was one of the first babies who
benefited from the pulse oximetry test. They didn’t even live in Connecticut, but they were lucky
to find that Connecticut offered this test that was recently implemented prior to their baby’s
birth. New York had not required all hospitals to have this test done on every newborn. Had they
had their baby in New York, their child would’ve most likely died from a critical congenital
heart defect (Grabell, 2013).
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The Unfortunate Reality
Taking a child home from the hospital with a congenital heart defect and not knowing it
can actually damage the heart even more, making it even more difficult to operate on the infant.
The whole point of this test is to detect the heart defect as soon as possible. One mother saw her
baby turn blue within seconds while she was wiping her baby’s face. She heard a pop in the chest
and saw her baby with blood coming out of its mouth. The baby went over a half hour without
oxygen and went into a coma, and later died. This mother was very unfortunate to not have this
pulse oximetry test to help save her daughter. The test is around $13.50 for use of equipment and
the time from the nurse. There are pulse oximetry tests available at local drug stores as well;
however it is better to have it done at the hospital (Grabell, 2013).
Tennessee Family
A newborn from Tennessee was examined by the obstetrician before and after birth. He
seemed like a perfectly healthy newborn, and would have been sent home with no question had
Tennessee not had the pulse oximetry test implemented. Many pediatricians find that they don’t
need the pulse oximetry test because they can find physical findings that the infant has a heart
defect (Hoffman, 2010). However, the physical examinations miss approximately half of all the
newborns who indeed do have a critical congenital heart defect (U.S. Health & Human Services
& Critical Congenital Heart Defects, 2011). The cardiologists found that he had a narrowing of a
blood vessel in his body. This narrowing blood vessel would of course become even narrower
over the next week or two, and eventually he would have died had he not had the test. He had
surgery and the blood vessel was corrected. Vanderbilt University hospital where this baby boy
was born normally sees around 12 babies go home each year with an undetected heart defect.
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That is why they had this legislation passed in Tennessee. It can only be assumed that they die,
they lapse into a coma, or it becomes very hard to operate on the infant (Saving the Life of a
Tennessee Newborn, 2013).
A Mother’s Movement
One mother, named Crystal Darak from Wilson, North Carolina, has rallied to bring
awareness to heart defects. Her child named Korah, died of a critical congenital heart defect in
May of 2011. Korah had hypoplastic left heart syndrome in which it required a heart transplant.
Korah was waiting for a heart transplant at the Duke University Medical Center in Durham,
North Carolina, while in the PICU. Crystal Darak was an advocate for the pulse oximetry test.
When Governor Pat McCroy signed into law the pulse oximetry test, she was there beside him
(“Wilson Woman Crusades for Health Screening”, 2013).
Pulse Oximetry Test in the UK
The Study’s Results
The United States is not the only country to create the pulse oximetry test for their
newborns. The UK tested infants in six maternity units. They had over 20,055 newborns, and of
all those newborns around 53 tested positive for a congenital heart, and 24 of those infants had a
critical congenital heart defect. Only .8% of the newborns received a false positive, which is
quite low considering the number or newborns they screened (Ewer, A. K., Middleton, L. J.,
Furmston, A. T., Bhoyar, A., Daniels, J. P., Thangaratinam, S., ... Khan, K. S, 2011). Around 1
in 3,000 babies had a false positive (Roan, 2011). According to Dr. Gerard Martin, from writer
Shari Roan’s interview, the European study also showed that the babies that had a false positive
also had something else going on that the doctors needed to look at. The newborns that triggered
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this false positive might also need some type of treatment to fix anything that the pulse oximetry
test might have caused to read as a positive for a congenital heart defect.
Fighting for Implementation
The UK is currently signing petitions in order to implement this test in all UK hospitals,
for the same reasons the US is (Johnson, 2013). Their study, however, was one of the largest
studies to determine the effects of the pulse oximetry test on infants, and the accuracy of the test.
The United States has yet to do a huge study, but the UK has a favorable outlook of the test
(Kasprak, 2011).
Conclusion
All babies deserve to be given a second chance in life. The pulse oximetry is able to
provide families reassurance, and newborns the opportunity to get corrective surgery or some
other procedure to fix their critical congenital heart defect. No parent deserves to put their
newborn to rest, after seeing them struggle to live. Some parents experience grief when they find
their newborn has been diagnosed with a critical congenital heart defect; however parents should
find comfort in the idea that the critical heart defect was detected early. The pulse oximetry test
has been found to be very accurate and it is noninvasive. Although equipment might cost a fair
amount of money, the idea that the test could cost as little as $1.00 is reassuring for many
advocates and parents. The switching of the sensor of the pulse oximeter to a blood pressure cuff
like sensor can cut the price by roughly 90%. Overall, parents, doctors, and many state
legislators have completely advocated for the implementation of the pulse oximetry test into
legislation and the future for newborns is looking bright.
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