Pulse oximetry. At this point most readers will yawn. What is it? Who cares? Pulse oximetry is something newborns need. The yawns widen; readers click off. We all know what newborns need. They need solvent parents, mothers who can breastfeed, a warm place to live, homes free from strife. Surely pulse oximetry is low down, at the bottom of newborns needs.
But pulse oximetry can save lives, costs little, and represents one positive action that state legislatures can take, in an era when most legislatures are impotent to do anything other than cut services.
Briefly, pulse oximetry is a screening tool to test for congenital heart disease. Each year 40,000 babies are born with congenital heart disease. The disease is not obvious at birth; indeed, newborns with congenital heart disease often look robust until they die. For some children, the disease will translate into early death. For others, the effect of the disease may not appear until years later.
The test costs about $25 per infant.
The test is non-invasive. A sensor, attached to a finger or toe, will measure the oxygen in the blood.
In the United States, the federal Advisory Committee on Heritable Diseases and Newborns and Children recommended it as part of the menu of newborn screening tests, and this September the Secretary of the Department of Health and Human Services gave the test an official green light. The American Heart Association supports the test. The United Kingdom, after a large study, advocates it.
At this point, the people who seek to shrink government would say stop. Let hospitals decide on their own whether to buy the machines. Let physicians decide on their own whether to test their patients. Let Uncle Sam, as well as Annapolis, Bismarck, Harrisburg, Tallahassee all the state legislative bodies bow out. Not their purview.
But we know that pulse oximetry can save lives. Consider New Jersey. On Aug. 30, a law went into effect, mandating the screening. The next day a newborn, who looked healthy, had the test. The test showed low oxygen levels. Ten days and one major surgery later, the newborn went home, this time truly healthy. We also know that without a governmental nudge some hospitals will adopt this new technology slowly.
States can provide that nudge. New Jersey, Maryland and Indiana require pulse oximetry. In Tennessee, New York, Pennsylvania, Nebraska, Missouri and Mississippi, parental and public health advocacy groups have introduced bills.
States have already stepped into the hospital arena, mandating an array of newborn screening tools. Depending on the state, hospitals may screen for phenylketonuria, galactosemia, congenital hypothyroidism, maple syrup urine disease, and hearing deficiencies, to name a few of the thirty possible maladies. Politically conservative parents who want government to exit from the health care arena could, I assume, request that hospitals not test their babies. But I doubt that any parents have put ideology ahead of their childrens health. And I suspect that even Tea Party parents are grateful for the mandates.
This New Year, state legislatures confront dwindling revenue, rising unemployment, and a persistent recession. Even though local politicians, running for office, promise to turn the state around, attract new businesses, solve their pension morasses, and turn red ink black, most state solons cannot do much.
They can, however, force hospitals to adopt a life-saving technology. Thats a good start for a New Year.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, January 1-15, 2012
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