Research Findings by UA College of Medicine Student Establish Feasibility of Pulse Oximetry Screening Guidelines for Newborns in Tucson

Published Date: 
Monday, June 3, 2013 - 9:16am
Pulse oximetry is a non-invasive, painless and inexpensive test conducted on newborns after 24 hours of life to detect critical congenital heart disease (CCHD). It measures the percentage of oxygen saturation in the blood. Low saturation levels indicate a possible congenital heart problem.
 
Babies born with CCHD may not have any signs or symptoms of a heart problem until after they leave the hospital. Problems typically emerge within the first four weeks of life, which may result in congestive heart failure or even death. This is why pulse oximetry is considered such an important and necessary screening: if detected early, CCHD can be diagnosed and treated, improving the child’s outcomes.
 
Pulse oximetry screening has been standard procedure in the newborn nursery at The University of Arizona Medical Center – University Campus since 2006. UAMC was the first hospital in Tucson to adopt pulse oximetry screening, based on research by then pediatric resident Michael Seckeler, MD. Dr. Seckeler conducted a pilot study funded by the UA Sarver Heart Center and overseen by his mentor Scott Klewer, MD, professor, UA Department of Pediatrics and researcher with the Steele Children’s Research Center. The results of the study provided evidence to the efficacy of employing pulse oximetry as a universal screening test to detect CCHD.
 
In 2011, the U.S. Health and Human Services Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC), the American Academy of Pediatrics, the American College of Cardiology Foundation and the American Heart Association made recommendations for newborn pulse oximetry screening of CCHD. The recommendations were based on research findings that had been conducted in regions at or just above sea level, causing concern that the established protocols — if followed in areas of higher elevation – might result in high rates of false-positives, causing unnecessary stress on the health-care system from additional required tests to verify CCHD in newborns.
 
“Arizona is one of 13 states that have not yet adopted this screening as a mandate, with elevation and the potential of false positives being two of many issues the state needs to consider,” said Dr. Klewer.
 
To address the elevation and false positive issues, UA medical student Lucy Han, working with her mentor, pediatric cardiologist Brent Barber, MD, associate professor, UA Department of Pediatrics, conducted a study to evaluate the feasibility of implementing the U.S. SACHDNC recommended pulse oximetry screening protocol in Tucson, with its elevation at 2,643 ft. Han’s research study was funded by the Medical Student Research Program (MSRP) at the UA College of Medicine. Han and Dr. Barber worked with the staff at the UAMC newborn nursery, evaluating the pulse oximetry readings of 1,069 newborns in 2012.
 
The findings of the study, “Feasibility of Pulse Oximetry Screening for Critical Congenital Heart Disease at 2643-Foot Elevation,” recently published in Pediatric Cardiology, established that implementing the screening guidelines recommended by the U.S. SACHDNC is feasible at an elevation of 2,643 foot elevation with a low false-positive rate.
 
“This is significant,” said Dr. Barber, “because now we have evidence that the protocol works at our elevation, and we can confidently continue pulse oximetry screenings using the existing recommendations without the fear of false-positive readings based on our elevation.”
 
Indeed, the life of a newborn boy was potentially saved last month when a pulse oximetry test revealed a critical congenital heart defect.
 
Born on April 22, Gabriel Blair was scheduled to be discharged from the UAMCnewborn nursery when a routine pulse oximetry test showed he had very low oxygen saturation—70-80 percent  (normal range is greater than 95 percent). A subsequent echocardiogram conducted by Dr. Klewer, revealed that Gabriel had a type of CCHD known as Total Anomalous Pulmonary Venus Return (TAPVR).
 
TAPVR is a congenital heart disease in which  the four veins that transport blood from the lungs to the heart are not connected normally to the left atrium and are instead re-directed to the right atrium. This prevents oxygen-rich (red) blood from passing from the left atrium to the left ventricle and on to the body as it should. Instead, oxygen-rich (red) blood returns to the right side of the heart rather than the left atrium, mixing with blue blood in the right atrium. TAPVR requires surgery to correct.
 
“Gabriel looked healthy, was breathing fine, eating well and we were about to go home,” said Gabriel’s mom, Emily Stiffe. “Thankfully, the pulse oximetry test detected an issue, which led to the early diagnosis of TAPVR.”
 
Pediatric cardiothoracic surgeon Michael Teodori, MD, professor, UA Department of Surgery, repaired Gabriel’s heart defect with open-heart surgery on April 26. He was discharged from the Neonatal Intensive Care Unit (NICU) at Diamond Children’s on May 3 and received a follow-up exam at the Arizona Elks Clinic for Children and Young Adults at UAMC when he was 18 days old. “He is doing well,” said Emily.
 
“I was amazed at how supportive both the hospital staff and parents were in implementing the pulse oximetry protocol, and I think it will be a great addition to the current newborn screening process,” said Han.
 
“It was a pleasure to work with Lucy on this research,” said Dr. Barber. “She took an active role in this project and saw it to its completion. Lucy gave an outstanding and well-received presentation of our research at a national meeting, the Western Society of Pediatric Research in January and was the lead author for the manuscript recently published in Pediatric Cardiology. Lucy is a highly motivated and bright student-scientist.”