Thinkstock

Anyone who’s had a baby is familiar with the battery of tests a newborn must undergo before he or she is deemed healthy and sent home.

One of the more recent additions to the list of such screenings performed on babies born at St. Charles hospitals detects a life-threatening condition called critical congenital heart disease, which kills more infants than any other type of birth defect.

The Bend hospital implemented the test, called a pulse oximetry screening, for all newborns over the summer to get ahead of a new law that soon will make the screening mandatory at all Oregon health care facilities.

The Redmond hospital has been performing them for about a year now, said St. Charles spokeswoman Lisa Goodman. The screenings also are performed at St. Charles Madras. (Babies are not delivered at the Prineville hospital.)

Doctors tout the test because it can detect a serious condition, it’s quick, inexpensive and noninvasive — it just requires placing a sensor on the baby’s hand and/or foot.

“It doesn’t involve any needles, it doesn’t involve much time, it can be done right there with the mom and dad present,” said Suzanne Zane, a senior epidemiologist in the Oregon Public Health Division’s maternal & child health section.

The road to implementation

Nearly 1 percent all newborns are born with congenital heart disease, an abnormality in which the heart is structured in a way that prevents it from properly delivering oxygen throughout the body. The Oregon Public Health Division estimates that between 300 and 400 of the 45,000 babies born in the state each year have congenital heart defects. The condition is considered critical if it results in life-threatening symptoms within the baby’s first year of life.

The Oregon Legislature passed a law this year that requires doctors to test newborns for heart defects before they leave the hospital, joining the more than 30 states in the U.S. with similar regulations in place.

Although a recent Oregon Health & Science University study found that more than half of health care providers in the Pacific Northwest already routinely screen for congenital heart disease, the new law aims to ensure that all babies born in Oregon are screened.

A pulse oximetry screening measures oxygen levels in the blood; lower levels could indicate a congenital heart disease. It uses a sensor that’s placed over a hand or foot.

John Peoples, chief of pediatrics at St. Charles Health System and a pediatrician with Central Oregon Pediatric Associates, said he places the sensor over both a hand and a foot because the condition can cause oxygen levels to vary among the body’s upper and lower extremities.

The law applies to hospitals and other birthing facilities, but does not cover babies born in homes.

Lawmakers tasked the Oregon Health Authority with developing specific rules around implementing the screenings. The law directs the OHA to adopt the rules by Jan. 1, but Dana Selover, manager of the Oregon Public Health Division’s health care regulation and quality improvement services section, said they haven’t yet assembled the committee that will write them, so it’s unclear when they’ll be ready. The law won’t officially take effect until the rules are finalized, Selover said.

“It’s a bit of a production, so to speak, to get the committee together,” she said. “We’re in the process of getting that organized and moving forward.”

It doesn’t always take a pulse oximetry screening to detect a critical congenital heart defect, said Alex Kemper, a pediatrics professor at Duke University. Sometimes, prenatal ultrasounds can identify the defects, he said. And even after the baby is born, an astute clinician can sometimes pick up on them, he said.

Oregon’s law requires only that the test be performed before the infant is discharged from the hospital. Kemper, however, said ideally, babies are tested within 24 to 48 hours after they’re born. A baby’s physiology changes dramatically from before they’re born to after, and testing before they’re 24 hours old increases the chance that the test could inaccurately test positive for a heart defect, he said.

Another consideration is that once babies are born, a duct that was once drawing oxygen from the mother to help the baby’s lungs grow begins to close, a process that takes two to three days. If a baby has an undetected congenital heart defect, they’ll face a life-threatening situation once the duct closes, Peoples said.

“What happens is these kids come in critically sick,” he said, “just a very high rate of mortality.”

If the heart defect is identified early, doctors can use medication to keep the duct open before the child undergoes heart surgery, Peoples said.

State follows U.S.

Pulse oximetry screening didn’t hit state lawmakers’ radars until 2011, when it was placed on the Secretary of Health and Human Services’ list of recommended newborn screening tests.

The Recommended Uniform Screening Panel is a list of more than 50 conditions doctors should screen for after babies are born. It includes strange and hard-to-pronounce ailments such as maple syrup urine disease and isovaleric acidemia, in addition to more commonly known ones such as hearing loss and cystic fibrosis.

Kemper was among the experts that helped gather evidence for the HHS secretary when pulse oximetry screening was added to the list. Shortly after, the American Academy of Pediatrics endorsed the screening.

Then came the flurry of state laws passed in 2012 and 2013 that mandated the screening.

“Now states are busy trying to implement it,” said Kemper, whose own state, North Carolina, is currently in the process of implementing its own law.

There are important questions to consider when implementing a pulse oximetry screening law, Kemper said.

For example, rural hospitals don’t always have echocardiograms, the device that’s necessary for follow-up in the event an infant tests positive for a heart defect, and it’s hard on families when a baby has to be transferred to another hospital, he said. For that reason, Kemper recommends states ensure there is a smooth protocol in place for babies that test positive.

That could pose an issue in Oregon, Peoples said.

“If you’re four or five hours from the nearest center where they can perform an echocardiogram and you’ve got to put a kid in an ambulance, then you’re talking about a lot of resources,” he said.

Direction on follow-up care could be included in Oregon’s rules, although the OHA would need to consider whether it has the authority to require anything beyond the screening, Selover said.

Elevation presents another complicating factor, as being at a higher elevation lowers oxygen levels in the blood and could increase the chance for false positives.

Officials at St. Charles considered Bend’s elevation — about 3,600 feet above sea level — when deciding on an oxygen saturation level that would denote a failed test, Peoples said.

Research has shown that a significant amount of money is saved when congenital heart defects are caught early, as that prevents emergency room visits and other complicating factors, Zane said.

There’s a human benefit, too, she said.

“It benefits our families and communities in Oregon and helps to support people while they’re still in the medical system,” Zane said. “It gets them the care they need while their babies are still in the birthing facility without going home and having an emergency.”

— Reporter: 541-383-0304, tbannow@bendbulletin.com