Saving little hearts

 In most countries, babies are screened at birth for 59 conditions. However, in India, rigorous newborn screening protocols are yet to be implemented, Dr Kishore Kumar tells Jisha Krishnan.

Congenital Heart Disease (CHD) refers to a range of heart defects that are present at birth and affect the normal functioning of the heart. They can range from minor defects with the baby not exhibiting any symptoms at birth to severe ones, which can be detected at birth and can be life-threatening. To tackle this issue, Cloudnine Hospitals recently partnered with Masimo, a global leader in non-invasive technology, to install a technology that’ll help screening for Critical Congenital Cyanotic Heart Diseases (CCCHD) in all its facilities.

“This technology overcomes some of the limitations present in the traditional saturation monitors. With this, any movement by the baby during screening does not interfere with the calibrations. And if the baby’s perfusion is poor, that is, poor passage of body fluid through vessels of an organ (either as a result of infection or a heart defect), then the technology takes this into account and gives an adjusted and more accurate reading,” informs Dr Kishore Kumar, neonatologist and chairman, Cloudnine Hospital, Bengaluru. Excerpts from an interaction:

What is the incidence of CHD in India?
CHDs are the most common type of birth defects. Worldwide the incidence of these is estimated to range from eight to 12 per 1000 live births. There is a lack of epidemiological data on the incidence of CHD in India, but according to one hospital study done last year, the prevalence is estimated to be 19 per 1000 births.

How can they be detected?
Some CHDs can be detected during pregnancy through a fetal echocardiogram. Others are detected after birth. They are of two types: cyanotic and acyanotic. In cyanotic CHDs,
the babies turn a bluish/purplish colour at birth so they are easier to detect. The skin colour of acyanotic babies remains pink so these defects are harder to detect. But if a doctor detects a heart murmur (an unusual heartbeat sound), notices changes in an X-Ray, if the baby shows signs of not developing normally, or has a persistent cold, then an electrocardiogram (ECG or EKG) and or echocardiogram is recommended to figure out what the heart defect might be.

What does a CCCHD screening entail?
The first few days after birth are the most crucial for detecting congenital heart
defects in babies to avoid long-term complications. Detection of CCCHD post that period significantly reduces the chances of survival. Immediately after birth, a baby should be screened to check breathing, heart rate, vision, heart and lung development and other biological functions. To screen for CCCHD, a pulse oximetry is done, which is a non-invasive tool allowing early diagnosis. It measures how well oxygen is travelling to parts of the body farthest from the heart. Newborn screening is mandatory in the United States and Canada. In India, currently, only the Government of Karnataka has made it mandatory to screen for five congenital biochemical defects in all government
hospitals. This is certainly not enough.

How expensive is the screening?
Pulse oximetry, a fairly inexpensive tool, is the test used to screen for CCCHDs. All maternity hospitals are supposed to be equipped with saturation monitors, so
doing a pulse oximetry should come at no additional cost to the patient. It is relatively easy to perform and can be done by a nurse or a trained medical technician. We plan to analyse how this new technology has enhanced our existing protocols to provide superior screening for CCCHD. We also plan to share our findings so that other
institutes in the country recognise the importance of newborn screening, which I hope becomes mandatory here soon.