Mandatory O2 test at birth.

deezee02deezee02 Posts: 1,509Registered Users
it is not mandatory yet, just something that is in the works.

i am really excited about this...an O2 screen is a great way to screen for heart defects without echoing every child...it is a little probe that attaches to their finger to tell their oxygin levels.

more details

In 2005 a member of the Tennessee state legislature proposed a bill that would mandate that all newborn infants born in Tennessee undergo pulse oximetry screening for the purpose of identifying those with critical structural heart disease before discharge home. A Task Force on Screening Newborn Infants for Critical Congenital Heart Defects was convened on September 29, 2005. This Tennessee Task force reviewed the current medical literature on this topic, as well as data obtained from the Tennessee Department of Health, and debated the merits and potential detriments of a statewide screening program. The Task Force Concluded that there was insufficient evidence to perform routine screening with pulse oximetry on otherwise healthy newborns at this time but that further study needed to be done.(1)
The estimated incidence of critical congenital heart disease is 170 in 100000 live births, and of those, 60 in 100000 infants have ductal-dependent left-sided obstructive lesions with the potential of presentation by shock or death if the diagnosis is missed. Of the latter group, the diagnosis is missed in 9 in 100 000 by fetal ultrasound assessment and discharge examination. (2,3) This group of babies are the ones who might be identified by a screening program. Identification of the missed diagnosis in these infants before discharge could spare many of them death or neurologic sequelae. Four major studies using pulse oximetry screening are available .(4,5,6,7) When data from these studies is restricted to critical left-sided obstructive lesions, sensitivity values of 0% to 50% and false-positive rates of between 0.01% and 12% were found in asymptomatic populations. Because of this variability and other considerations, a meaningful cost/benefit analysis could not be performed. It was the consensus of the task force to provide a recommendation to the legislature that mandatory screening not be implemented at this time. However, it was determined that a very large, prospective, perhaps multistate, study is needed to define the sensitivity and false-positive rates of lower-limb pulse oximetry screening in the asymptomatic newborn population. The task force also noted that there needs to be continued partnering between the medical community, parents, and local, state, and national governments in decisions regarding mandated medical care. It is the purpose of this proposal to begin to provide the information necessary to determine if such a screening program is possible and beneficial in Tennessee.
Procedure
A pulse oximeter will be provided to each of the 32 hospital delivery services who agree to participate in the C.H.E.S.T. study. The protocol will be to obtain a pulse oximetry saturation reading from a lower extremity of each baby. The test will be done after 24 hours of age but prior to discharge. The screening will be recorded on the data collection form.
A persistent reading below 95 will require notification of the baby’s health care provider. If a repeat evaluation demonstrates a pulse oximeter reading of 95 or less then a referral phone call will be made to the investigating center (Vanderbilt Children’s Hospital 322-2275). The result of the screen will be discussed with a neonatology consultant. If deemed appropriate the baby will then be evaluated by a pediatric cardiologist. The Pediatric Cardiologists at Vanderbilt as well as the the private cardiologists of the Little Hearts group in Nashville have agreed to evaluate the babies identified by screening. The result of the pediatric cardiology evaluation will be recorded. The decision regarding the timing and mode of transport if necessary of the baby for evaluation will be made between the pediatric cardiologist and the referring health care provider. The VCH Cardiology Division has agreed to provide 24 hour a day support for evaluation of these infants in order to minimize time of uncertainty for the family and referring provider.
Budget
This important research is presently unfunded. However the Nellcor company has agreed to review the proposal and has at least verbally agreed to consider providing the equipment and probes necessary. Drs Walsh , Liske and Greeley at Vanderbilt have agreed to perform the data collection and evaluation. We will be requesting funding from granting agencies within and outside the state to complete the data analysis.
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Comments

  • iris427iris427 Posts: 6,002Registered Users
    I hope they'll make sure it's actually effective before instituting such a policy.

    Obstetrics is famous for assuming something will make a difference in a mother's or baby's health and then making it routine before ever actually testing its efficacy (e.g. constant electronic fetal monitoring)
    3027585431_55b6195e50_s.jpg3028374752_0df4d81a1b_s.jpg3028422696_8dcef38baa_s.jpg
    TickerTicker.aspx?&TT=bdy&TT1=bdy&CL=29&CT=&CG=F&O=m_nestbirds&T=t_b14&D=20080913&M1=&D1=2009&T2=&T1=Baby+Iris&CC=0&CO=&step=5&radio=A
  • M2LRM2LR Posts: 8,630Registered Users Curl Connoisseur
    iris427 wrote:
    I hope they'll make sure it's actually effective before instituting such a policy.

    Obstetrics is famous for assuming something will make a difference in a mother's or baby's health and then making it routine before ever actually testing its efficacy (e.g. constant electronic fetal monitoring)

    I think that constant electronic fetal monitoring is something MUCH different than checking their O2 levels in their blood by slipping a little do-hickey on their finger or toe. the electronic fetal monitoring is so much more invasive.

    I think that it sounds like a good idea, deezee.
    :rambo:
  • iris427iris427 Posts: 6,002Registered Users
    M2LR & Co. wrote:
    iris427 wrote:
    I hope they'll make sure it's actually effective before instituting such a policy.

    Obstetrics is famous for assuming something will make a difference in a mother's or baby's health and then making it routine before ever actually testing its efficacy (e.g. constant electronic fetal monitoring)

    I think that constant electronic fetal monitoring is something MUCH different than checking their O2 levels in their blood by slipping a little do-hickey on their finger or toe. the electronic fetal monitoring is so much more invasive.

    I think that it sounds like a good idea, deezee.

    I was referring to external monitoring, with the bands around the belly. In most hospitals, the external monitoring is what's routine--the more invasive, internal monitors are not routine.

    I realize they are different and I know what a pulse ox is. My point was just that the OB culture has a history of instituting routine tests, monitoring, policies, etc. without making sure they will actually be beneficial.

    I'm all for something that actually helps moms and babies stay safe and healthy. But I've seen a lot of medical stuff that doesn't and they do it anyway.
    3027585431_55b6195e50_s.jpg3028374752_0df4d81a1b_s.jpg3028422696_8dcef38baa_s.jpg
    TickerTicker.aspx?&TT=bdy&TT1=bdy&CL=29&CT=&CG=F&O=m_nestbirds&T=t_b14&D=20080913&M1=&D1=2009&T2=&T1=Baby+Iris&CC=0&CO=&step=5&radio=A
  • deezee02deezee02 Posts: 1,509Registered Users
    OB's are not the ones pushing for this, mainly CHD foundations and pediatic cardiologists/surgans...

    so many LO's go home and the defect does not show for days/months/even years later.
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  • iris427iris427 Posts: 6,002Registered Users
    deezee02 wrote:
    OB's are not the ones pushing for this, mainly CHD foundations and pediatic cardiologists/surgans...

    so many LO's go home and the defect does not show for days/months/even years later.

    Again, if it can lead to earlier detection for the babies, great.
    3027585431_55b6195e50_s.jpg3028374752_0df4d81a1b_s.jpg3028422696_8dcef38baa_s.jpg
    TickerTicker.aspx?&TT=bdy&TT1=bdy&CL=29&CT=&CG=F&O=m_nestbirds&T=t_b14&D=20080913&M1=&D1=2009&T2=&T1=Baby+Iris&CC=0&CO=&step=5&radio=A

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