By Alex Ginsberg
It costs almost nothing, takes less than a minute and can save a baby's life.
Dr. Robert Koppel, a neonatologist at Schneider Children's Hospital, has recently developed a safe, noninvasive and amazingly simple test for potentially deadly heart abnormalities in newborn babies.
Although obstetricians generally catch heart abnormalities during pregnancy by performing ultrasound screenings, there are problems that can slip by.
“You have a group of babies who are in the regular nursery, they look pink, they look well, and when you examine them, you may not find any abnormality,” he said. “If they leave the hospital and get sick at home, they can potentially die.”
The problems are generally due to heart valves that are too small or completely closed.
To perform the new test, nurses wrap a device called a pulse oximeter around a baby's foot. One side of the oximeter shines a red light into the skin, while another part collects and measures the amount of light that emerges on the other side of the foot.
The device has been in common usage for adult patients since the late 1980s, although it must be applied to small extremities such as toes or earlobes.
A newborn's foot, however, is thin enough for the device to work. Too much light passing through the baby's foot tissue indicates that the child's blood is oxygen deficient, which may in turn suggest a possible heart abnormality.
Koppel applied the test to 11,000 newborn babies at LIJ in New Hyde Park and Good Samaritan Hospital in West Islip over 18 months in 1998 and 1999, then waited another two years to be sure that none of the babies who passed the test eventually developed problems. Analysis and presentations at medical conferences followed, and Koppel finally published his findings in the March 2003 issue of Pediatrics.
“Most of the credit goes to the nursing staff, who performed the screening tests,” Koppel said. “This is something they were very eager to perform, because they understood the importance of trying to diagnose illness. … It would give them reassurance that they were not sending a baby home that might come back later in critical condition.”
Of the 11,000 babies screened, three were found to have heart abnormalities, Koppel said. None of the children pronounced healthy by the test later showed signs of heart problems.
The next step, Koppel said, is to convince state health departments across the country to add pulse oximetry to the battery of tests administered to newborns.
Although the type of heart abnormalities that can be detected by pulse oximetry are rare – roughly one in 1,000 babies develops them – the procedure is both inexpensive and noninvasive.
Pulse oximeters cost about $2,000, but most hospitals already have them on hand and the devices are reusable.
“We used two probes for our entire sample,” he said. “It took just about one minute of nursing time, which is negligible.”
Koppel said babies who show signs of a problem after the pulse oximetry test should be referred to a specialist for an echocardiogram, a diagnostic test that can definitively determine whether there is an abnormality.
The cost of an echocardiogram – from $800 to $1,000, according to Koppel – precludes its use as part of the panel of tests given to every newborn.
The response so far has been encouraging, Koppel said. New York state is considering adopting the test, and a parents' organization in New Jersey, Empty Arms, is pushing its state to begin pulse oximetry.
“I've received inquiries from Arizona, where there are planning discussions on this screening method to be added to their panel, and I've been in contact with physicians in England, Poland, Italy, Israel and China,” Koppel said. “It's taken on a life of its own.”
Reach reporter Alex Ginsberg by e-mail at Timesledger@aol.com or call 718-229-0300, Ext. 157.
