According to the National Family Health Survey, the infant mortality rate (IMR) in India stands at 34 per 1000 live births. About 10% of these infant deaths can be attributed to congenital heart diseases (CHD) alone.
About 1.5 lakh infants are born with CHD in the country every year, a condition which can be detected with timely screening. Considering this, relevant stakeholders and institutions came together to launch a campaign for formulating a national policy on making CCHD screening mandatory in all healthcare establishments in India.
Current screening methods that include physical examination, fetal scan or a combination of these two can only detect 72% of the cases. Various clinical studies have shown that addition of reliable pulse oximetry to screening protocols can potentially increase the detection rate to 92% which in the Indian context can approximately save about 52,000 babies. This will further have a direct impact on IMR.
Speaking during the discussion, Dr K K Aggarwal, President, Heart Care Foundation of India (HCFI), said, "Many newborns with critical CHD are symptomatic but not identified or diagnosed until after discharge. Such a delay in diagnosis increases the chance of frequent hospitalisation and can cause mortality in the longer term."
Newborn screening for CHD Risks
"Newborn screening is thus an important strategy to ensure that no babies die due to lack of a proper screening mechanism. This issue requires the formulation of a national policy that will make screening for CCHD a priority even in primary healthcare establishments in the country. This can be made a reality if all relevant stakeholders join hands and support the cause."
CCHD screening can also detect other birth defects including sepsis, respiratory disorders/lung pathology, persistent pulmonary hypertension, and transitional circulation. Countries that already have mandated and/or have adopted this screening methodology include USA, UAE, Saudi Arabia, Sweden, Norway, Sri Lanka, China, and Australia. USA already boasts of a 33% decline in infant deaths from CCHD in eight states due to timely screening.
"Pulse oximetry is a proven technology in detecting critical heart defects in infants. However, during my research, I gathered that not all pulse oximeters are the same. Institutions launching CCHD programmes should therefore choose a reliable technology after considering all aspects."
"Infants affected by CCHD can have poorer outcomes if there is a delay in diagnosis and treatment. Diagnosing these conditions before infants leave the hospital can prevent complications and more importantly, mortality," said Dr Anne Granelli, NU Hospital Group, Sweden.
Some signs of CCHD in infants include loss of healthy skin color; Cyanosis (a bluish tint to the skin, lips, and fingernails); rapid or troubled breathing, swelling or puffiness in the face, hands, feet, legs, or areas around the eyes; shortness of breath or tires easily during feedings; sweating around the head, especially during feeding; and poor weight gain.
"The current scenario in terms of the number of infants that die due to CCHD is grim. It further necessitates the need to implement a policy at the national level at the earliest. A pulse oximetry screening is not only inexpensive but takes less than 2 to 3 minutes per baby, with the benefits far outweighing the costs."
"The screening can even be carried out by an ASHA health worker with basic training. We are sure that this high-level meeting and discussion among relevant stakeholders will help us reach a consensus and get positive results," concluded Dr BD Bhatia, President, The National Neonatology Forum.