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pulse oximetry test question

Discussion in 'General Chat' started by RainbowChaser, Jan 14, 2010.

  1. RainbowChaser

    RainbowChaser Well-Known Member
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    I know this may seem like a strange question but anyway:

    I am wondering whether the Pulse Oximetry test is a standard test done on newborns in the UK? and if not why the test is not done as standard?

    In recent weeks I have been reading the tweets of Kristine Brite on Twitter and her campaign to make these tests standard practice in America and was just wondering about whether or not they are used in this country or whether the situation is the same as America.

    Thanks for any help given
     
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  2. Roo

    Roo Well-Known Member

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    er pulse oximetry as a standard test? why? what would the indication be for even needing it? if the baby is breathing then surely the sats are fine -what would the results tell us and what would really be done about it in all honesty? facial oxygen? -and also - the results are really not going to be expected to be completely 'normal' due to the transition between fetal circulation and neonatal/normal circulation systems i would imagine....

    just my thoughts, sorry i can't help. my 2 week placement in the neonatal unit is next week though so may see it being done perhaps???

    would be interested to find out more -i have never ever heard of it though. i don't have twitter so is there some way i could see it without having to go on that?
     
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  3. RainbowChaser

    RainbowChaser Well-Known Member
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    I'll search out the link to her website but her story is basically:

    At five days old her baby daughter, Cora, passed away while breast feeding. She was told after her daughter's death that she had Congenital Heart Disease (CHD).

    The Pulse Oximetry test I believe is able to uncover heart problems in babies related to the level of oxygen and is most effective at around 24 hours old.
     
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  4. RainbowChaser

    RainbowChaser Well-Known Member
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  5. 1in100

    1in100 New Member

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    I don't know how many hospitals are doing pulse ox screening in the UK, but many are in the US (of their own choice). There are many, many people working to ensure all babies are screened with pulse oximetry before discharge. I am part of a group doing a pilot study in Minnesota - which will advance us further toward universal screening. To answer Roo's comment...the screening is done between 24-24 hours after birth, which significantly reduces any false positive rates associated with screening too close to birth. Not only does pulse ox catch upwards of 65% of known congenital heart defects, it catches a number of other respiratory or lung issues that may be missed with routine clinical exam only.

    A pulse ox does not, obviously, detect IF a child is breathing. It gauges the level of oxygen in the blood. This is ONLY compromised if there is a serious issues with respiration or heart function. For the 1in100 babies born with a congenital heart defect, this extra level of screening WILL save lives. Far too many babies are still discharged from the hospital with undetected defects (mild murmurs or none at all). These babies end up in acute, high distress situations (or worse) that could have been avoided with early detection.

    I am honored to know Cora's mother...she is working wonders to spread awareness of heart defects and the need for newborn screening. I have no doubt her daughter would be alive if she had received a pulse ox screening before discharge.

    Gratefully our baby Eve was diagnosed at 2 days old. At 5 days old, she was in heart failure. She was very nearly sent home, and would never have made her one week well-baby visit. She was able to make it into her second week of life on a cocktail of 8 medications that kept her alive for the next 12 weeks. She had two surgeries in Boston last year that saved her life. Happy to answer more questions if you have them...I will be attending the national newborn screening advisory committee meeting next week in Washington DC - where this exact topic is on the agenda.

    Here are some details on pulse oximetry screening that might help...

    What is Newborn Screening with Pulse Oximetry?
    Pulse oximetry monitoring uses a light source and sensor to measure oxygen in the blood.
    A soft, wrapped sensor is wrapped around the baby’s foot.
    Light passing through the foot measures the amount of oxygen in the blood.
    The test is quick (3-5 minutes) and painless. Pulse oximetry monitoring should detect most heart defects.
    Why is it important to check babies for heart defects?
    If undetected, some congenital heart defects can cause serious or even life-threatening problems. Early detection and early treatment lead to better outcomes.
    Why check the blood oxygen level with pulse oximetry?
    A low oxygen saturation level may indicate the presence of a heart defect.
    What are the benefits of the screening?
    Babies are less likely to be sent home with unidentified heart problems – some of which can cause acute, emergency situations or even death. If identified in the first 24-48 hours of life, medical teams are available for diagnosis and treatment of CHDs. Critical congenital heart defects, requiring immediate treatment or repair, can be performed before discharge from the hospital.
    Will screening find all types of heart defects?
    No current screening tool exists to detect CHDs 100 percent of the time. Pulse oximetry screening should detect most heart defects (those associated with a low blood oxygen level). However, some heart detects may not be found on screening (those not associated with a low blood oxygen level).
    What will happen if a baby has a low blood oxygen level?
    The pulse oximetry test will be done again. If the level is still lower than expected, then an echocardiogram (sonogram of the heart) will be done. A pediatric cardiologist will ‘read’ the echocardiogram to check for the presence of a heart defect. If a CHD is found, the pediatric cardiologist will start collaborating on those findings and working on treatment options. Most heart defects can be corrected or improved with surgery, procedures and/or medications.
    What are the other signs and symptoms of heart defects parents can watch for?
    • Baby tires easily during feeding (falls asleep before feeding finishes)
    • Sweating around the head, especially during feeding
    • Fast breathing when at rest or sleeping
    • Pale or bluish skin color
    • Poor weight gain
    • Sleeps a lot, not playful or curious for any length of time
    • Puffy face, hands and/or feet
    • Often irritable, difficult to console
    Congenital Heart Defects (CHDs) are defects that are present at birth and affect the structure or function of the heart or vessels.
    • Heart defects are the most common birth defect.
    • CHDs occur in approximately one of every 100 births.
    • About 40,000 babies with CHD are born in the US each year.
    • Heart defects are the leading cause of newborn and infant death.
    • Although some babies will be diagnosed before birth or at birth, sometimes the diagnosis is not made until days, weeks, months or even years later.
    Share
    [​IMG]

    Annamarie, 1in100 (Facebook), 1in100.org
     
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  6. iolaus

    iolaus RM and Head of Clinical Practice
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    Only done if they seem dusky.
    I do think though things are more likely to be missed in the US as they don't have the postnatal care we do in the UK with midwife visiting just after discharge
     
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  7. iolaus

    iolaus RM and Head of Clinical Practice
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    It is routinely done on special care babies (mainly because if they have too high a level for long periods it can cause blindness)
     
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  8. Lilbea

    Lilbea Guest

    Thanks for the info 1in100 - very informative!
     
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  9. Roo

    Roo Well-Known Member

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    Thanks for that 1in100 -i'm so glad your Eve made a good recovery, and hope that Cora's death can help others and that it bring her parents some light in that knowledge xxx

    what kinds of heart defects can they detect on ultrasound sonography then? as far as i was aware they scan the hearts here for defects at about 20-21 weeks -i would have assumed that these picked up the majority of defects??? sorry i know it's all questions!

    when you say, "Not only does pulse ox catch upwards of 65% of known congenital heart defects, it catches a number of other respiratory or lung issues that may be missed with routine clinical exam only" does that mean that in cases of CHD that are already known -then the pulse oximetry only picks up 65% of these cases? or is it that it can identify 65% of different types of CHDs?? just wanted some clarification sorry.

    will go and read the links (and probably answer my own questions i suppose!). Good luck on the committee meeting.
     
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  10. iolaus

    iolaus RM and Head of Clinical Practice
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    Only 25% of heart defects are picked up by USS
     
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