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At Norwalk Hospital newborns will undergo a new test

Dr. Vicki SmetakDr. Vicki SmetakEvery baby who will be born at Norwalk Hospital, beginning next year, will receive a new state-mandated test to check for congenital heart defects.

Gov. Dannel Malloy signed the bill in July, which takes effect Jan. 1.

Dr. Vicki Smetak, chair of pediatrics, said Norwalk Hospital has already begun to plan for the procedure that will affect about 1,600 infants annually.

The test, which is called pulse oximetry screening, is being done, she said, “so we’re not missing any previously undiagnosed cases of cyanotic heart disease.” With sophisticated fetal echocardiograms and monitoring processes, cases are usually picked up in utero. For babies whose mothers have late, little or no prenatal care, this test will pick up undiagnosed cases.

The test is non-invasive and involves placing a sensor attached to a piece of tape on the baby’s foot. It can also be attached to the hand. The sensor must stay in place for 15 minutes during which the baby must be quiet, but not asleep.

It also cannot be done within the first 24 hours, since an infant’s fetal circulation is shutting down and the child is adjusting to life outside the womb. It is ideally performed during the first 36 to 48 hours of life.

“If the oxygen saturation is under a certain number, it will require a second screening,” said Dr. Smetak, who lives in Weston. The second test would be conducted later the same day.

If the results of the second test are not high enough, an echocardiogram would be ordered, which is an ultrasound of the heart that would identify any lesions.

Dr. Smetak emphasized a poor result on the test does not guarantee heart disease; there are a number of other causes of low blood oxygen levels. However, if an echocardiogram is ordered, a pediatric cardiologist will come in promptly to read it.

“We will have pediatric cardiology coverage 24/7,” she said. “We will have a cardiologist come in and read the echocardiogram, see the family and baby, and talk with them before the baby is sent home.”

She also emphasized these are all well babies that will be tested, where the incidence of congenital heart defects is just a few per 100,000 births.

“Even with a positive screen, it’s not likely a baby will have a heart lesion,” Dr. Smetak said. “But we won’t send a family home without knowing.”

Extensive training

The test itself is not expensive — the sensor costs about 25 cents — but there will be a large investment by the hospital in manpower.

“There is a huge training piece to this,” Dr. Smetak said. How to get the reading, the numbers to look for, the clinical protocols to put in place are all things to be worked out over the next few months. Dr. Smetak said hospital officials hope to be ready ahead of Jan. 1, and are aiming for November implementation.

The other piece of this new procedure is making sure there is ample medical coverage in case an infant does test positive. Dr. Smetak said the response was “overwhelmingly positive” from team members from nurses to cardiologists to be available weekends and holidays if needed.

Other tests

The pulse oximetry screening will be just one of several routinely conducted on newborns. Cyanotic heart disease — one type is tetralogy of Fallot — occurs when the blood circulated through the body is depleted of oxygen, resulting in skin that looks blue, which is called cyanosis. In some cases, such as hypoplastic left heart syndrome, parts of the left side of the heart do not develop completely.

Newborns at Norwalk Hospital are also given a transcutaneous bilirubin test. Bilirubin is a substance found in bile produced when the liver breaks down old red blood cells.

The neonatal metabolic screen, in which blood is taken from a heel stick, tests for a number of metabolic and genetic disorders such as hypothyroidism, sickle cell anemia, and cystic fibrosis.

The law mandating pulse oximetry screening in newborns has been endorsed by the American Heart Association, which called it “life-saving.”

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