Critical congenital heart defect is a serious, even life-threatening, condition that occurs in infancy, and it is seen in approximately 18 in every 10,000 babies. Although the statistics may not cause any significant alarm, it is a condition that should be addressed immediately upon diagnosis.
Unfortunately, there is no guarantee that CCHD can be detected early on in the pregnancy, or even upon assessment in the nursery as it may not show objective signs right away. Because of this, some infants who have the condition end up discharged at home, where they rapidly decompensate.
CCHD, which is also referred to as critical congenital heart disease, is a structural heart defect that is usually associated with hypoxemia—the lack of oxygen in the blood—among newborns. There are many types of CCHD, ranging from mild to severe, which may involve abnormalities in the rhythms of the heart to problems in its structure. It may also involve holes in the heart, abnormal or absent chambers, and abnormalities in cardiac function.
Infants who are tested positive for CCHDs will need surgery or catheter intervention soon after birth or within the first year of life. Without proper and prompt treatment, these infants have a higher risk for morbidity or mortality at such early age.
Infants who have CCHD are usually treated successfully if the problem is detected early, giving them the chance to live longer and healthier lives. This is where a CCHD screening is important.
Screening for CCHD
More and more hospitals are now conducting CCHD screenings to newborns, and for a good reason. It will most likely detect seven types of CCHDs, which includes tetralogy of Fallot, hypoplastic left heart syndrome, tricuspid atresia, truncus arteriosus, transposition of the great arteries, pulmonary atresia, and total anomalous pulmonary venous return.
There’s no denying that it is a valuable tool for prompt detection of CCHD among infants. Moreover, pulse oximetry screening is inexpensive, noninvasive, and easily accessible, being easily performed at the patient’s bedside.
Usually performed within the infant’s first twenty-four hours of age, a pulse oximetry test is conducted using a pulse oximeter, with probes placed on your baby’s right hand and either foot. This procedure measures how much hemoglobin in the blood is saturated or filled with oxygen.
Passed or Failed Screens
A CCHD is considered failed if the infant’s oxygen saturation is less than 90 percent during the initial or repeat screens. The screen is also failed once results from a Welch Allyn SpO2 sensor measures less than 95 percent in the infant’s right hand and right foot for three measurements with one-hour intervals. Infants who have failed screens will need to be evaluated for causes of hypoxemia and may be required to undergo other lab tests, such as an echocardiogram.
Meanwhile, a passed test is when the baby’s oxygen saturation measures more than or equal to 95 percent in the right hand or right foot. But since pulse oximetry screening is not capable of detecting all critical CHDs, it is still possible for an infant to have this condition even with a passing result.
To avoid getting a false positive result, health-care providers need to screen the infant while he or she is wide-awake and alert and at least twenty-four hours old.
If your baby is tested positive in the pulse oximetry screening, further evaluation will be made before you are discharged from the hospital. Take note that an out-of-range result does not necessarily confirm that your baby has CCHD.
It still simply means that your baby is showing low blood-oxygen levels—which can be caused by many factors. But because of the harmful effects that CCHD may bring shorty after birth, it is vital for your child to undergo further testing as soon as possible to rule out the possibility of a heart problem and to set appropriate interventions in place.