Thanks to an Iowa mother, the state now requires that all hospitals screen newborn babies for congenital heart defects. Sara Lockie of Ankeny, Iowa, began her fight for the simple screening after her son was born with a series of heart defects. Her advocacy eventually led the legislature to make a change.
The screening is called pulse oximetry. The screening takes place at approximately 24 hours of age, and the baby passes screening if the oxygen saturation is 95% or greater in the right hand and foot and the difference is three percentage points or less between the right hand and foot. It’s painless, can be done in as little as 45 seconds and costs around $4 a baby. This process, which is done by sensors, will screen more than 27,000 new babies each year.
The New Screening
Pulse oximetry tests blood oxygen levels and can detect signs of heart defects. If the levels are off, doctors can order more tests in an attempt to discover any unseen heart problems. Thirty-five states now require this test at all of their hospitals.
In New Jersey, the program has been around for three years. The screening led to further testing that found heart defects in 13 of the 183 babies that failed the oximetry test during that time. That’s 13 babies helped before their problems became worse.
Statistically, 9 out of every 1,000 babies are born with congenital heart defects. One-fourth of the defects are considered critical. Heart defects are the leading cause of infant death in the U.S., and they are also the leading birth defect overall. These babies spend much of their time in the Neonatal Intensive Care Unit and surgery, while parents manage lengthy hospital stays. These extended stays not only put stress on their little bodies but can also lead to other complications.
According to Wassef Karrowni, MD, of UnityPoint Clinic Cardiology "Congenital heart disease, or congenital heart defect, is a type of abnormality or defect in one or more structures of the heart or blood vessels that occur before birth while the fetus is developing in the uterus. It may be diagnosed before birth, right after birth, during childhood or not until adulthood.” The term “congenital” means existing since birth.
Types of Congenital Heart Defects
There are 18 recognized types of heart defects that are congenital:
Aortic Valve Stenosis (AVS)
A valve from the heart to the baby’s body does not properly work.
Atrial Septal Defect (ASD)
Cardiologist Georges P. Hajj, MD, of UnityPoint Clinic Cardiology explains this type of heart defect:
“An atrial septal defect is a large hole between the upper two chambers of the heart. ASD is more likely to affect the heart chambers, causing an enlarged right heart, and possibly right heart failure. It can also be the cause of a stroke. Most ASD can be closed with a simple percutaneous procedure, unless they are very large. In that case, they may require surgical repair.”
Coarctation of the Aorta (CoA)
The aorta, or major artery, is narrowed.
Complete Atrioventricular Canal defect (CAVC)
There is a hole in the center of the heart where all four chambers connect.
d-Transposition of the great arteries
There is a reversal of the two main arteries in the body that carry blood to the lungs and body.
There is a heart valve that does not properly close.
l-Transposition of the great arteries
The lower section of the heart is completely reversed, and blood flow pattern is reversed.
Patent Ductus Arteriosus (PDA)
There is a hole in the aorta.
Pulmonary Valve Stenosis
A valve in the heart is too thick to open fully.
Single Ventricle Defects
One of the lower chambers is either too small, underdeveloped or missing a valve.
Tetralogy of Fallot
This defect includes a hole between the lower chambers, a blockage from the heart to the lungs, a condition where the aorta is over the hole in the lower chambers and the muscle around the lower right chamber is too thick.
Total Anomalous Pulmonary Venous Connection (TAPVC)
This is a defect in the veins between the heart and lungs that doesn’t allow them to connect.
This is a condition where one of the large arteries is missing.
Ventricular Septal Defect (VSD)
This is a hole in the wall between the lower chambers.
Risk Factors for Congenital Heart Defects
A study from the American Academy of Pediatrics found that the risk of a baby developing a heart defect increases when the mother smoked during pregnancy. It also stated that the more the mother smoked, the higher the risk became. If a mother smokes while pregnant, the baby’s risk of developing a heart defect of the valves and blood vessels goes up by 50 to 70% and the risk of holes in the heart goes up by 20%. The researchers determined that 1 to 2% of heart defect cases are caused by smoking.
Other congenital heart defect risk factors include:
- Contracting Rubella, or German measles, during pregnancy
- Having diabetes prior and during pregnancy, not including gestational diabetes
- Certain medications like those containing thalidomide, isotretinoin, lithium and valproate.
- Drinking alcohol during pregnancy
- Family history of heart defects
If your child has a congenital heart defect, Dr. Karrowni wants you to know it’s not always predictable:
“If you have a child who has a congenital heart defect, you may think you did something wrong during your pregnancy to cause the problem, but very frequently doctors don't know why congenital heart defects develop. Sometimes it could be linked to toxic exposure neonatal development. Smoking during pregnancy also has been linked to several congenital heart defects. Most congenital heart disease, however, appears to be caused by genetic abnormalities, a few of which have been well described. Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. Heredity may play a role in some heart defects and in rare cases if more than one child in a family is born with a heart defect."
More than ever before babies are being screened for heart defects. It’s time that every state require these simple tests. In honor of American Heart Month, let’s take care of our littlest hearts together.
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