Congenital Heart Screening Becomes Law in Missouri
At a ceremony at St. Louis Children’s Hospital, Missouri Governor Jay Nixon has signed into law a bill requiring all newborns in the state be tested for critical congenital heart disease (CCHD) before leaving the hospital.
St. Louis Children’s Hospital has led an effort to develop a standard for screening in nurseries at three BJC hospitals. Barnes-Jewish Hospital, Missouri Baptist Medical Center, and Progress West Hospital began voluntarily screening newborns with pulse oximetry in March and April.
A pulse oximeter, is a small cuff that fits around a baby’s hand or foot and reads the level of oxygen in the child’s blood, along with his or her heart rate. The results can help doctors detect several of the most common congenital heart defects, including hypoplastic left heart syndrome, transposition of the great arteries and pulmonary atresia.
“Critical congenital heart disease accounts for 40 percent of deaths from all birth defects,” says Cynthia Ortinau, MD, Washington University neonatologist at St. Louis Children’s Hospital. “We know a child can be in a nursery and looking well but have congenital heart defects that are life-threatening. We want to identify these children before they go home and experience further complications.”
For the past year, a team of physicians, nurses, and staff from St. Louis Children’s Hospital, Washington University School of Medicine, and BJC HealthCare hospitals, as well as community pediatricians, has been working together to integrate the pulse oximetry screening into routine newborn testing, says Dr. Ortinau, who co-chaired this effort with Sherrie Hauft, MD, a Washington University neonatologist at St. Louis Children’s. They have also developed information now available for parents on Labor & Delivery units to explain the non-invasive screening, as well as a comprehensive Critical Congenital Heart Disease Program toolkit for other hospitals.
“Pulse oximetry is a quick, simple, and inexpensive screening tool that improves our detection of CCHD before these babies are discharged home,” says Ortinau. “By detecting these lesions early we may make a significant difference in the lives of these children.”
Endorsed by the American Academy of Pediatrics, U.S. Department of Health and Human Services, and the American Heart Association, pulse oximetry screening is now viewed as the national standard of care for newborns, says Dr. George Van Hare, MD, Co-Director of the St. Louis Children’s and Washington University Heart Center.
“Those children referred to St. Louis Children’s Hospital will have a cardiology evaluation consisting of a complete echocardiogram, plus a cardiology consultation if requested by the newborn medicine service,” says George Van Hare.
Dr. Van Hare says the hospital and the Heart Center team are available to support diagnosis and treatment of infants suspected of having critical congenital heart disease, either through telemedicine facilities or by on-site evaluation after transport to the hospital’s NICU.
They recently cared for a patient with hypoplastic left ventricle syndrome who was referred from another hospital after being discovered by that hospital’s screening system.
“The infant would have otherwise been discharged home with the mother at less than 48 hours and might well have had a disastrous outcome,” he says. “Instead, the baby was stabilized, transported by air to our hospital, and had heart surgery with a good result.”
St. Louis Children's Hospital has provided specialized care for children for more than 130 years. US News & World Report ranks St. Louis Children’s among the Top 10 pediatric hospitals in the nation. In 2010 the hospital received the Magnet re-designation from the American Nurses Credentialing Center, the nation’s highest honor for nursing excellence. St. Louis Children’s Hospital is affiliated with Washington University School of Medicine, one of the leading medical research, teaching and patient care institutions in the nation. The hospital is a member of BJC HealthCare. For more information, visit www.StLouisChildrens.org, or visit us @STLChildrens on Facebook and Twitter.