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October 4, 2011 > Santa Clara Valley Medical Center screens newborns for heart defects

Santa Clara Valley Medical Center screens newborns for heart defects

Submitted By Joy Alexiou

An estimated 1 percent of every newborns in the United States, or 40,000 babies each year, is born with a structural defect of the heart. Some defects are relatively benign and may show up later in life but others can be critical and require medical and surgical attention in the early newborn period.

While the heart is the organ most prone to abnormality at birth, there has not been a universal approach to screening the heart. Early detection may prevent babies from becoming acutely ill and thus improve morbidity and mortality in children with congenital heart disease.

"We're extremely proud of the important work we've done in screening all babies, especially of our most recent work of screening babies for heart defects," said Dr. Balaji Govindaswami, Chief of Newborn Medicine and Director of the Santa Clara Valley Medical Center (SCVMC) Neonatal Intensive Care Unit. "The screenings in our hospital, along with the screenings at O'Connor Hospital (OCH) and other hospitals around the country, contributed to a new recommendation from the Secretary of the US Department of Health and Human Services."

SCVMC and OCH are among the first in the nation to implement pre- and post-ductal screening, which is conducted at 24 hours after birth and looks at oxygen levels in a newborn for a first sign of possible heart disease. Dr. Govindaswami shared the results of the first 4,000 babies screened at SCVMC when he testified to the Secretary's Advisory Committee on Heritable Disorders of the Newborn in October 2010. On September 21, 2011, the Secretary of the US Department of Health and Human Services recommended that screening for heart disease be added to the Universal Screening Panel for newborns. Dr. Govindaswami's testimony included the findings of conducting oxygen level screening on both the right hand and a foot, which is in the September 21 recommendation.

In June 2009, Dr. Priya Jegatheesan began the heart screening program for newborns at SCVMC. In July, 2011, Dr. Cathy Angell, Chair of Pediatrics at OCH and Director of the NICU at OCH, implemented identical screening for babies born at OCH.

"Newborns with heart disorders may well appear normal at birth. This screening is conducted with babies who show no symptoms when they are 24 hours old," stated Dr. Priya Jegatheesan, Director of the Well Baby Nursery at SCVMC. "It's very rewarding to be part of the effort to get screening for heart disease in the national recommendations and have it be one of only two national screening approaches that are not blood-spot related and non-invasive."

Since the early 1960s, more than 150 million infants in the United States have been screened for a number of genetic and congenital disorders. The Universal Screening for newborns includes screenings for 30 core disorders and 26 secondary disorders and in the last decade this screening has been implemented nationally. The other non-blood screening conducted with newborns is for hearing, which has been mandated for more than 10 years. These screening programs are recognized as being essential for providing the best care and outcomes for infants.

"The oxygen level screening for heart disease is the best indicator for possible problems. For example, in the same time period we have conducted 120 echocardiograms on babies who we thought may have a heart problem by physical examination. All but one of these ultra sounds was normal but when we used the hand and foot oxygen screening, three more babies were identified as having heart defects," commented Dr. Govindaswami. "This early recognition led to successful treatment of these babies. With appropriate follow-up and care, these infants will be able to develop normally. I'm proud of the work of our team and very happy for these babies and their families. It's a great result for everyone involved."

The Secretary of Health and Human Service's Advisory Committee on Heritable Disorders in Newborns and Children works to reduce morbidity and mortality in newborns and children who have or are at risk for severe or lethal conditions. The testing and follow-up services of newborn screening programs are designed to provide early diagnosis and treatment before significant, irreversible damage occurs. The generally acknowledged components of a newborn screening system include education of professionals and parents; screening (specimen collection, submission, and testing); follow-up of abnormal and unsatisfactory test results; confirmatory testing and diagnosis; medical management and periodic outcome evaluation; and system quality assurance, including program evaluation, validity of testing systems, efficiency of follow-up and intervention, and assessments of long-term benefits to individuals, families, and society.

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