Monday Medical: Newborns provide key data
July 29, 2012
Steamboat Springs — A quest to determine the normal oxygen saturation in healthy babies born at Yampa Valley Medical Center has attracted national and even international interest.
Since December 2011, YVMC neonatal nurse practitioner Tracie Detwiler has published a nursing journal article, met with a state representative and corresponded with medical professionals from Tennessee to Israel.
Although Detwiler had hoped that her research would have widespread value, she never anticipated this whirlwind of attention.
"This has been a fantastic, serendipitous outcome due to the timing of our published research and a growing emphasis on screening newborns for critical congenital cardiac disease," she said.
To explain this ripple effect, we have to go back to the beginning and provide some history.
"When I began working at YVMC in 2000, I noticed we were sending quite a few newborns home on supplemental oxygen," Detwiler said. "I had previously worked at sea level, where home oxygen use was not as common. My question was, 'What is normal at this altitude?'"
Detwiler discovered there was no published research that related specifically to Steamboat Springs' altitude. She enlisted Patricia Ravert, Ph.D., a nursing educator at Brigham Young University in Utah, to lead a new scientific study.
The study included six hospitals in three states at altitudes ranging from 4,498 feet in Provo, Utah, to 8,150 feet at Vail.
Detwiler said parents gave enthusiastic permission, and YVMC was able to test 325 babies born between October 2007 and September 2008. Combined data from participating hospitals went into the December 2011 article in "Advances in Neonatal Care," co-written by Ravert, Detwiler and Jane K. Dickinson, a diabetes educator at YVMC.
In general terms, the research showed that many healthy newborns tested at these altitudes showed an oxygen saturation rate of less than 95 percent. That percentage is significant, because it is being recommended as the threshold of screening for critical congenital heart disease.
"This is a hot topic in the medical world," Detwiler said. "Several states already have passed laws for screening, and Colorado is considering legislation.
"However, if a pulse oximetry reading of 95 percent is used as the threshold, without taking altitude into consideration, our research indicates that too many babies in Steamboat Springs would be subjected to unnecessary testing."
Of the 325 babies tested at YVMC in the 2007-08 study, 28 percent to 45 percent registered less than 95 percent of oxygen saturation when tested at 12 to 72 hours after birth.
The Centers for Disease Control and Prevention reports that some babies born with a serious heart defect can appear healthy and be sent home with their families before their heart defect is detected. Critical congenital heart disease is thought to affect 11.6 of every 10,000 babies born in the United States.
"We are totally on board with the need to screen for critical congenital heart disease, but we need to scientifically and accurately identify at-risk infants," Detwiler said. "These tests can cause parental anxiety, and they are expensive.
"We feel that we are ahead of the curve in demonstrating through published research that national recommendations don't apply to babies born at this altitude," she said.
To date, Detwiler has been contacted by a medical student in Israel, a Children's Heart Foundation advocate, a Tennessee physician serving on a national advisory committee, a Colorado epidemiologist and a Colorado physician who wants to do more research.