Newborns get heart tests at Hilo Medical Center

West Hawaii Today - May 22, 2014
Colin M. Stewart

Hilo Medical Center is now regularly performing a simple and cheap test on newborns that can help catch congenital heart defects while they can still be corrected.

The policy change was instituted by the hospital April 7 after failed attempts in the Legislature to require the tests for all babies born at public hospitals statewide. The test, known as pulse oximetry screening, measures oxygen levels in the blood and can warn of a group of heart defects that can cause life-threatening problems. Those health problems must be addressed with emergency care within the first few days of life, or even surgery within the first year of life, before the heart is done developing.

The testing has become an industrywide standard in states across the country. But, despite the test’s usefulness and low cost, pegged at about $1 per test, Hawaii is one of only 15 states in the union that has not passed any laws requiring its use, according to the American Heart Association.

During the recent legislative session, a pair of House and Senate bills was floated to require the screenings for newborns, but both failed to become law at the end of the session. “A recent survey of Hawaii birthing centers indicated that all but two neighbor island hospitals already apply pulse oximetry screening on all newborns,” reads testimony supporting Senate Bill 2194 from Donald B. Weisman of the Hawaii chapter of the American Heart Association.

“However, disparities exist on screenings at Maui Memorial Medical Center based on the infant’s health insurance provider (Kaiser physicians order the test for babies insured by its organization, while other babies go unscreened), and at Hilo Medical Center where the screenings are not performed on any newborns. SB 2194 … would help to ensure that all Hawaii families are provided with the most recent standard of care-based health screenings for their newborns.”

The failure of SB 2194, introduced by state Sen. Mike Gabbard, was a disappointment to state Sen. Josh Green, D-Kona, Ka‘u, who works as an emergency room physician at Kona Community Hospital and serves as chairman of the Senate Committee on Health. “We passed the bill through to conference committee out of (the health) committee in the Senate, but then one of the House members applied an 80-page, unconnected rider to the bill calling for something totally different,” he said. “A fight broke out … and the bill died. I was very disappointed to see it. I simply wanted to see us be able to detect these cardiac problems for newborns.”

He added that the last-minute addition of unrelated material to the bill, introduced by House Rep. Romy Cachola, D-Sand Island, Mokauea, Kapalama and Kalihi Kai, is a somewhat frowned-upon tactic to push through legislation with very little public input, and it ultimately dragged the bill down with it.

“It was kind of a bush league thing to do,” Green said. “I’m sure that as a result, there were a couple babies that didn’t get tested who might have needed it.” While the bill did not pass, it was successful in shedding new light on the importance of pulse oximetry screening, which prompted Hilo Medical Center to require last month that the screening be used as part of its regular procedures, according to Dan Brinkman, the center’s chief operating officer.

“(The bill) was a way to get the attention on the issue and the priority raised to a new level to get all hospitals doing the same thing for our keiki,” he wrote in a text message. On Wednesday, Nursing Supervisor Joyce Murata and obstetrics unit Nurse Manager Christina Ranan demonstrated the testing process on 2-day-old Treyson Moniz. They taped a pair of wires to the child’s hand and foot, and his blood oxygen levels appeared almost immediately on a small readout on the machine’s screen. “It’s a really simple process,” Ranan said. Keisha Moniz, the boy’s mother, said she was glad to hear the test is being included among the dozens of other blood, hearing and vision tests that are performed on newborns at the hospital.

“It’s better to know early,” she said. “You worry about your baby. You automatically want to know if he can see all right, can he hear all right. You worry.” A Maui Memorial Medical Center spokesman said Wednesday that most doctors at the hospital use the test regularly, although the facility is now the only hospital in the state that doesn’t specifically require the test be done in all cases.