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Perspective

Perspective

France may have the #1 rated health system in the world, but it’s highly doubtful my newborn daughter would have survived there. I rarely use this forum to weigh in on broader health policy and political issues.  This is a home for CHD – and our journey having a child with this birth defect.  But as someone schooled in economics, particularly health economics, it’s become increasingly difficult to brush off the over-simplification of our reforming healthcare system.  These random (and all too common) comparisons to damn near every other country on the planet are nonsense.  There are no other direct comparisons to the U.S. healthcare system, or the U.S. population, for that matter.  We’re talking 50 states here, with massive diversity, across a huge geography, each with its own cottage industry of healthcare.  It would be like comparing acquired heart disease among 12 different countries with no methodology in place for lifestyle, routine foods eaten, age, access to care, etc.  Frankly the healthcare system in France may be just perfect, for France.

So…to the commentators, if you are going to compare something like, say MRIs – which according to the International Federation of Health Plans costs on average $335 in Britain and $363 in France, and $1,121 in the U.S. – let’s also look at other key factors surrounding that cost.  Do the compensations for the technicians and the specialists involved in conducting and reading that MRI align in every country?  Should they?  Does it cost the same amount of time and money to education technicians and physicians in every country?  Is the equipment being used comparable? Who is making the decision to order that test?  Are the criteria the same…meaning, would the same patient be prescribed an MRI in say, France, as in the United States?  And what are the costs associated with the care of those diagnosed (or that go undiagnosed without the test)?

We’ve all heard the arguments of “over utilization” in the era of healthcare reform.  Many of those arguments are valid and deserve the scrutiny and quality improvement currently underway.  But the idea that a one-size-fits-all approach to medicine (or even population health) is what’s best for human beings…well, that’s just naive.  Notice I said “human beings”…not “patients”, not the “health system”.

I have no doubt that if my daughter Eve were born in nearly any other country on this planet, I would just be another grieving mother.  This is certainly true in the developing countries of the world, where surgery for newborns with critical congenital heart disease is simply not available.  But it is almost certainly also true in other developed nations too, including most of the ones ranked as having “better” healthcare than the United States.  It’s not just a matter of the caliber of physician or training, but a public health mentality embedded in the care system – one that without necessarily trying to – must simply allocate resources and care differently.

Our daughter’s heart defects were of the caliber that the vast majority of physicians would have thrown in the towel.  Ours didn’t.  It took a little bit of extra research, some feisty parents of other CHD babies, and a whole lot of serendipity to create the perfect storm that got our baby the care needed to repair her heart. But ultimately it was up to the doctors and institutions collaborating on her care to CHOOSE to save her life, with cost not being the criteria (note: for the record, I have long been an advocate for cost transparency in healthcare).  The tragic fact is, not just many, but MOST families from other parts of the world – even when their children have a CHD of lesser complexity – are simply given the devastating news: “there’s nothing we can do.”  That is that.  No more diagnostics, no supplemental interventions to extend life (time that might be used to try a different course of treatment, or get that child to a place that CAN change the outcome). The economics must also be factored in when this sort of pathway becomes the medical out-clause. With pediatric or adult patients – there are ramifications – job loss, divorce, costs of palliative or hospice care, or options being pursued in other places, on an emergent basis.

Yes, I do a great deal of work in health policy, and have had the great fortune to know hundreds of parents traveling the CHD road…along with the clinicians and public health professionals that serve these families. But I don’t write this with any authority other than that of a parent, whose child has endured months of hospitalization, dozens of chest x-rays and echocardiograms, 8 MRIs and 4 surgeries.  She has been under anesthesia 9 times in the past year alone.  I understand that having a child with CHD and a brain tumor makes us a double-fringe case.  We are healthcare super-users.  But I know with absolute certainty we would not want to be anywhere else on this planet.  We have our daughter – playing on the floor next to me now – to show for it.

I wish there were more stories about the bright spots in U.S. healthcare, for there are tens of thousands of those stories every single day. Lives saved. Families grateful to their core that they could get care they needed, when they needed it. But instead, we only hear about what’s broken.  And if I have had any sideline criticism of the reform process, it has been that one side could only focus on what was broken  - essentially throwing the baby out with the bathwater, while the other side couldn’t admit to the things that ARE broken. Whatever the many pitfalls of the U.S. healthcare system are, they can and will be overcome. Retain and embrace what’s good. Fix what isn’t. But above all, recognize that we need a better U.S. healthcare system, not to morph into that of another country.

 

It’s Father’s Day. Where’s the Baby Book?

It’s Father’s Day. Where’s the Baby Book?

I remember our daughter Eve’s first haircut.  It happened on Saturday night, at 2 AM.  She was 9 days old.

Paul and I were in the usual half-sleep that comes with having a child in an ICU.  We were down the hall from the PICU at the University of Minnesota Children’s hospital, and had just heard the dreaded “code blue” come over the intercom system.  This time was different.  About 2 minutes later, my cell phone rang.  It was the ICU attending physician asking us to come down.  I flew out of our makeshift floor-bed and RAN like hell the 50 or so yards to where Eve was.  “Is it Eve??”  No, calm down, they said.  Apparently all her tiny veins were blown out from days of fluids and meds being pumped into the body of 5.5 pound newborn…the only place left to place the IV was in her head.  They needed to shave some of her beautiful dark hair

Eve Saarinen, with Elle and Jack, 10 days old, U of M Children's PICU

- and didn’t want us to freak out when we came in the morning.  They saved her locks of hair for us.  We still have them to this day.

What we don’t have is the proverbial Baby Book to put them in.  There’s nothing on paper historically documenting Eve’s first coo.  Her first smile. Her first babble, first tooth or first roll-over.  This, I suspect, is a sad reality for too many of the families whose babies face critical illnesses. There are simply more important things to focus on when your kid is fighting to survive. I just told my mom this morning that I cannot recall being at Eve’s baptism. I know we had one…it was at our church even.  But it wasn’t long before we were prepping to go to Boston Children’s Hospital for her heart surgeries and our brains must have been mush. Gratefully we live in the era of cell phone cameras, or we probably wouldn’t have any photos of Eve. Frankly, it’s a little tough to be in “photo shoot” mode while your baby is hooked up to a dozen lines and monitors.  While these images may be hard for others to look at, we treasure those grainy pictures.  She was so serene and lovely – yet tough as nails.

Eve Saarinen, April 2009

We also live in the era of Facebook, Twitter and blogs. Eve is fortunate to have a daddy who qualifies as an “early adopter” of these methods of communication and historical documentation. Random fact: Eve’s older sister Elle’s birth was hailed by the Sydney Morning Herald as the first live-tweeted delivery).

Paul was a champion at keeping our close friends and family posted on what was happening with Eve in the hospital.  It’s hard to express how grateful I am for this.  He took photos, he blogged. He DID the baby book.  Virtually.  We can still access most of it.  And may go through the process of pulling Facebook and blog posts into a more permanent format, so Eve can read her own story someday, as so many others have told it too.  Some of Paul\’s posts were so profound (still are, even this week)  that I still revisit them now and then for a moment of thankfulness and grounding.

Eve and Paul, Children's HeartLink gala, 2009

We think she’s a pretty cool kid – with a pretty cool story (minus the actual baby book).  For now, the locks of hair, the pulse ox wrap and her ankle bracelets can stay in a keepsake box.  Her life continues to be full of firsts.  The dates don’t really matter.  What matters is that she came to us, she powered through, and she is here to ask her daddy all about it.

Eve’s Journey + A Heart Ball

Eve’s Journey + A Heart Ball

On the eve of Eve’s 4th birthday, honored to be sharing comments from the American Heart Association’s Heart & Stroke Gala on December 8, 2012….with profound thanks to the AHA for their commitment to early detection, research and advocacy for the youngest congenital heart patients.  Newborn CCHD screening is the organization’s top policy priority for 2013.  These remarks followed a video presentation of Eve\’s journey produced by the AHA. The event raised more than $900,000.

I want to thank everyone here tonight for your enthusiasm and generosity…and special thanks to AHA, and the rest of our family for being there through the journey.

4 years ago this week, our lives changed forever.  Eve was our Christmas gift – perfect on the outside, but broken inside.

There are people in this room tonight that we are forever indebted to – Dr. Lazaros Kochilas, whose compassion and craft kept Eve’s heart functioning long enough to get her to life saving surgeries – done in collaboration with Dr. Pedro del Nido at Children’s Boston.  Even more impressive – the willingness of these clinicians to look at options that would help avoid delayed diagnosis of CHD in newborns…to provide greater options for treatments and intervention.  Dr Kochilas, Dr. Jamie Lohr, and several other physician leaders at U of M Amplatz, Regions, Children’s and Mayo Clinic have donated hundreds of hours to this endeavor…and every family having a baby should be grateful for their efforts.

As everyone has mentioned tonight, we’ve come so far. We know that if Eve had been born 15 years earlier – when Jack was born, she would not likely have survived.  In that short time we have made so many advancements – a testament to advances in diagnosing and treating congenital heart defects.

But even with the amazing tools that are out there, so often due to lack of funding or resources, those tools are still not available to the doctors and nurses who need them.

We will continue to work with the American Heart Association …. to invest in CHD research and programs….to advance statutes and legislative requirements for newborn heart screening here and in states across the country.  Thankfully, our state continues to lead…just yesterday I was with the Commissioner of Health, who just a few weeks ago proudly authorized statutory language that adds Newborn Screening for CCHD to the state panel.  But we still need policy help to ensure there are resources available for hospitals to do this as a population health screening and collect important data on the results for each baby tested.

Pulse Oximetry evaluation is a key first step in helping us catch critical congenital heart disease early so it can be treated.

But there is still more to do and more funding needed to develop the science to nail down the causes of CHD, and provide treatment to these kids as they grow into adulthood, advancing the specialty of Adult Congenital Heart Cardiology.

My dad and my grandmother both had rhuematic fever as children….as a young woman about my age, my grandmother became Dr. Lillehei’s 3rd surgical patient on the heart lung machine in the 1950s – which gave her another 5 years of life.  My dad had his heart valve replacements at Mayo just 6 months after Eve’s OHS.  I only wish he and my mom were here tonight….

We’ve had the privilege of volunteering with AHA, long before our lives were so profoundly touched by heart disease. I was on the steering committee for this very event more than 13 years ago, when Jack was just Eve’s age.  That year, a teenager stood on this stage post-transplant, and talked to you about the importance of early detection and the advancements in treating CHD.  That boy, now an adult with someone else’s generous heart beating in his chest was just elected to the Minnesota legislature and will be sworn in as a state rep in January.  Congratulations Nick Zerwas.  What a story.  I expect to see you often this session in the halls of the legislature – and fully expect your signature on any legislation on CHD coming your way.

Finally, please remembers, that in just the time we’ve been together tonight, more than 50 children have been born in the U.S. with a congenital heart defect (40,000 this year). 10 percent of these babies will not see their first birthday.  We need research and advocacy to keep improve those numbers…

Your support tonight makes an impact.  Thanks to Eve, our house is one where we don’t sweat the little things, and we try to keep our eye on the ball.  We’re skipping the Barbies and castles at our house this year….so please join us in giving generously tonight.  Profound thanks to each of you…   ~ Annamarie Saarinen

The good with the bad.

The good with the bad.

Studies and peer-reviewed journal pieces have become standard reading over my career.  After Eve’s CHD and the founding of 1in100, even more so.  While in most cases, these are the types of publications that warrant credibility by name alone, it’s important to note that not everything published is direct science, has perfect methodology, or frankly, is to be taken as gospel.

It’s always exciting to see another published article on newborn screening for Critical Congenital Heart Defects.  The more info out there among clinicians, the faster the adoption rate.  That’s because 99 percent of the published pieces on this topic (at least since 2010) have been in support of routine screening of newborns for heart defects.

Two more editorial and commentary pieces hit the circuit this week in The Lancet: Kemper Screening of newborn babies Lancet 2012

and

A new milestone in the history of CHD Lancet 2012

There are some very important points addressed in each, most of which I fully agree and support.  Some of the comments – not so much.  To suggest the importance of better prenatal detection is of critical CHD is one thing.  To add that the purpose of such is solely to give families the choice of termination is entirely another.  The example used is Hypoplastic Left Heart Syndrome, which most would argue is now being treated with a high rate of success.  (See Gil Wernovsky, MD commentary: The Paradigm Shift Toward Surgical Intervention for Neonates With Hypoplastic Left Heart Syndrome.  To be sure, there are thousands of children in this country, and around the world, now surviving and thriving with HLHS.  To disregard this important clinical progress is a discredit to those patients, to those individuals and institutions providing interventional care, and to future families faced with this diagnosis.

With many scientific paper and editorials, we have to take the good with the bad, hoping that in most cases, the good far outweighs the bad.  Onward and upward.

 

Collateral Damage

Collateral Damage

I had an opportunity to be in Boston a few days ago – and to visit Children’s Hospital Boston.  A fellow Minnesota family is there right now with their 8 month old baby girl, recovering (beautifully) from a heart surgery at the hands of Eve’s surgeon, Dr. del Nido (their cardiologist at the University of Minnesota Amplatz Children’s Hospital is also ours, Dr. Kochilas.)  Baby Maddy’s room was two doors down from our old room – 8E, right across from the nurses station.  It all came flooding back.

It was 3 years ago this week that my husband and I flew our 3.5 month old baby from Minnesota to Boston to fix her heart.  She had just a couple weeks left to live.  I don’t remember being anxious or afraid. I remember being confident.  We were doing the right thing. She was going to come home with us and grow up to be a happy, healthy girl.  Somehow I knew this to be true.

I’ve told people many times since, that it was our mission at that time to never bring fear or pain into Eve’s ecosystem.  No matter how tired, discouraged or nervous we were along her difficult newborn journey – we were always positive and upbeat around her hospital bed.  Always.

There was always a scarf in her little isolette that smelled like mommy or daddy.  We must have recited Brown Bear, Brown Bear a thousand times.  We played the Disney Lullabies CD over and over.  And that musical seahorse.  I still wake up hearing that sometimes…

Even during pokes and painful procedures, we would just tell her how we were sorry, but that she was so very brave and strong. She needed us.  That is certain.

Sometime when we took a walk outside her room, it was all we could do to stand.  There’s no way to explain this type of sheer exhaustion unless you’ve been there.  We needed others – to lean on when we left her room.  Our hearts shine from the friendships we have gained because of Eve and her broken heart.  For every lost friend (unfortunately there were some), we have gained 10 new ones.

One of the great human tragedies of pediatric disease is the loss of friends, family, support systems. Again, no one can understand unless they have been through it. Nearly every day, I hear a heartbreaking story of how a best friend never came to visit the hospital.  How parents, brothers, sisters…and yes, even spouses, just bail. Sick infants are not the things of story books and fairy tales.  Tubes, wires, monitors, cuts, stitches, blood.  Congenital heart disease is an abomination.  No child should have it.  Period.

But until the day when children suffer disease no more, reach into your soul to BE THERE for those you know going through a traumatic health experience with their child.  BE THERE for those you barely know.  And BE THERE for those you don’t know. Suck. It. Up.

Eve is 3 now. She is the happy little girl I promised her she would become.  And someday soon, I hope we can share her amazing story with her – and teach her one of the most valuable word in the human vocabulary: compassion.

It’s Awareness Day…and??

It’s Awareness Day…and??

February 14  is Congenital Heart Defect Awareness Day.  It’s also the day our 2 month old almost lost her life on the way to a hospital emergency room.  Not a great memory or reason to celebrate.  But is is a reason to share, which is what thousands of families are doing on this day.

When Eve was diagnosed at 48 hours old, the doctors said she had unknown “congenital heart defects” and possible pulmonary hypertension of the newborn, resulting in a diagnosis of Congenital Heart Disease.  What is “congenital”??  Is that like “congestive” heart failure?  Is it a disease?  Or a defect?   Tip: do not Google “pulmonary hypertension of the newborn” from your hospital bed at 2 AM after they have taken your baby away to the ICU.

She would struggle to make it past one week old.  But after she did – through a cocktail of 7 round the clock medications to keep her heart functioning – we started digging into what CHD really meant.  Fact: we had no clue.  And I had been around heart stuff…serving on advisory committees for the American Heart Association and Children’s HeartLink…and had personal friendships with some of the pioneers in cardiac medical devices.  My dad had Rheumatic fever as a child – and had subsequent heart issues.  His mother – my grandmother – was a blue baby, and in the 1950s was among the first patients on Dr. Walt Lillehei’s heart lung machine.  That surgery extended her still abbreviated life by almost 5 years…long enough to see one of her 4 boys graduate high school.

Still, with all this, I was a complete idiot on CHD.  This deer-in-the-headlights response recurs almost daily when we use the term (or the acronym) to explain what happened to our daughter Eve.  People just don’t get it.  Lumping Critical Congenital Heart Disease (CCHD) in there – and seriously, it’s almost time to throw in the towel.

The simplest way around this so far has been this: Eve was born with heart defects that caused her heart disease – which she will have for the rest of her life.

I think what’s unique to the CHD community is that we are dealing with a BIRTH defect.  Explaining that’s what “congenital” means is important, but not required.  I think great strides can be made when we start talking about “heart defects” and “heart disease”.  People CAN get their heads around that.  And they can talk to others about the prevalence, the need for research and the astounding progress that has been made to improve the long-term survival rates.

At 15 and 16 weeks old, Eve would undergo two surgeries to repair her heart defects.  Her recovery after was nothing short of miraculous. Today, she is a boisterous 3-year-old with only the remnants of the scars from her open heart surgery.  1in100.org and facebook.com/1in100 began with the purpose of connecting families and impacting health policies that can improve outcomes for pediatric heart patients.

The first priority was early detection of critical heart problems that kill and compromise babies.  Heart defects are the leading cause of infant death from birth defects, claiming the lives of more than 4,000 babies in the U.S. each year.  Fortunately, a simple, non-invasive test in the newborn nursery can help clinicians detect possible heart problems, ensuring earlier intervention and better outcomes.

It was a two-year crusade.  One that reinforced the utter lack of understanding of what CHDs are and how often they occur.  One percent of newborns are impacted. The population surviving with congenital heart disease is growing 5 percent each year.

This month, I have the sincere honor of presenting hospital Grand Rounds with Eve’s cardiology team in Minnesota, and will be addressing the topic of newborn screening for heart defects at Cardiology 2012, attending by clinicians and medical experts from around the world.  I’m safe with the CHD and CCHD acronyms among these folks.  It’s the rest of the world that needs to understand.  And if kicking the acronyms to the curb works, then let’s roll with it.

The Birth Announcement (That We Didn’t Want to Send)

The Birth Announcement (That We Didn’t Want to Send)

Eve Isley Saarinen was born the evening of Friday, December 12th  – 6 lbs, 9 oz, 20 inches… lots of beautiful dark hair.

At 2 days old, Eve was diagnosed with congenital heart disease. It’s a broad category.  Her biggest problem is a severely leaky mitral valve, which puts strain on the whole heart function, enlarging the heart and putting pressure and excess fluid on the respiratory system.  She was transported by Lifelink to the University of Minnesota NICU on the 14th.  Paul drove through the blizzard that night to be at her side, but since I had a c-section I could not be discharged until the next day.  Took a cab over there on the 15th and we hunkered down for the next 5 days.  The medications seemed to be working at first, but within a couple days her heart was continuing to get larger, her breathing more labored.  After an episode of SVT – which is basically super-fast heart arrhythmia, she was immediately transported to the U of M Children’s Hospital pediatric intensive care unit – closer to the full time cardiology staff and cardiac surgeon.

She was started on a new, stronger drug to alleviate some of the pressure and workload on her heart.  We were warned that her situation was precarious.  The surgeon and team spoke to us of a possible transplant (her heart had already been greatly damaged by her defect and the tachycardia).  Yet with all this, she has started to turn a corner and improve.

It is slow progress – and it’s hard to be patient.   We don’t know how long we’ll be here as the medicines do their work…though they seem to be stabilizing her.  We’ve told our parents to come now…want them to know her if God takes her from us now.  Just writing this is almost unbearable.  For now, we are only positive around her…so we cling to a tentative plan to get her bigger and stronger for a heart surgery at about 3 months old.

There are very sick children all around us here.  It’s the holiday season and there shouldn’t be any sick children.  Anywhere.  So we pray for all these babies and continue to be grateful for how well Eve has been doing.

Blessings to all of you in the new year – cherish your new arrivals.  They are the greatest gifts.  We’ll do our best to keep you posted (Paul’s Eve blog updates can be found at:  www.tweetandmeet.com)

Annamarie, Paul, Jack, Elle and baby Eve

On a roll…

On a roll…

Another significant journal weighs in on pulse oximetry to help detect CCHD. Nature Reviews Cardiology: Clear benefits of pulse oximetry in neonates—one small step to improving postnatal cardiac care.

The letters, emails and calls recognizing the importance of the U.S. Department of Health and Human Services decision to recommend this simple screening for all newborns has been overwhelming.  I was reminded once again, this week that far too many children still receive a delayed diagnosis of congenital heart disease.  There is still much work to be done…in honor of the 70-plus families who lost their infants to heart defects this week.

Universal Newborn Screening for Heart Defects Recommended

Universal Newborn Screening for Heart Defects Recommended

SACHDNC Meeting 9/22
Public Comments
Chairman Howell, Committee Members,

Thank you for allowing this participation today.  As of yesterday afternoon, the comments I had prepared have greatly changed.  We are overwhelmed by the Secretary’s positive response to this committee’s vote from one year ago to recommend newborn screening for critical congenital heart disease.

In support of this important screening – over the past few months, the following occurred:

  • Meetings with nearly 80 ( 77 ) congressional offices
  • Information briefings provided to 12 additional offices within HRSA and HHS, including the Secretary’s office
  • Four formal congressional briefings by the Newborn Coalition
  • Drafted and delivered dozens of letters to stakeholders, provided fact sheets, cost analytics, and shared updates on the status of the recommendation and response to the CHD community, public health and         health IT committees and leadership
  • Working directly with New Jersey’s Dept of Health implementation workgroup
  • Established pilot projects that support MU stage 3 care coordination and electronic reporting of pulse oximetry results

In just the year since the committee voted to recommend newborns be screened for CCHD, more than 120 additional hospitals around the country have started screening newborns for heart defects as a standard of care.  Pennsylvania has introduced legislation and New Jersey’s Governor signed their bill.  As of Aug 31, 2011, every newborn in New Jersey is being screened, using the protocol developed by the HRSA implementation working group.  All this happened in New Jersey in less than 8 weeks time…an amazing accomplishment, and a model for other states.

The number of hospitals screening grows every week, including an annual population of 15,000 babies in Minnesota.  We have also translated all our our parent educational materials into 3 languages and have a working IT project with MN Dept of Health to support electronic results reporting – one we hope to open source for every state attempting to set up similar procedures for collecting and reporting pulse oximetry data.

I hope this effort has reinforced something important – that the work here reaches beyond metabolic screening.

Today, 11,000 babies will be born in the United States.  110 will be diagnosed with some type of congenital heart problem.  11 of them will die before their first birthday.  No question – through your important efforts, that number WILL CHANGE.   Fewer lives will be lost to this insidious disease.

My dad was diagnosed with stage 4 cancer last week.  Here’s what no daughter wants to hear: we would have had more options had we known sooner.  It’s also what no parent of a baby wants to hear.  Early diagnosis of hidden diseases and disorders MATTERS.  You help make that happen.

On behalf of my family, 1in100, the CHD community and the Newborn Coalition, many thanks to this committee for the work you do and continue to do.

And thank you Chairman Howell – you have done work that will be recognized by generations.  You leave some very large shoes to fill. Wishing you all the best.

Thank you again.

Annamarie Saarinen, 1in100 / Newborn Coalition

Consensus – AAP, AHA, ACC Endorse Screening Newborns for Heart Defects

Consensus – AAP, AHA, ACC Endorse Screening Newborns for Heart Defects

Published in the journal Pediatrics: Endorsed by the American Academy of Pediatrics, the American Heart Association and the American College of Cardiology, a federal advisory panel recommends nationwide screening for critical congenital heart disease using pulse oximetry, a probe placed on a hand and a foot that uses a light source and sensor to measure oxygen in the blood. Low oxygen levels signal the need for further testing to look for a heart-related problem.

View the report here: Newborn Screening for Heart Defects Using Pulse Oximetry Recommended

There are few words to describe the excitement.  Thinking back to Eve’s Impact, her diagnosis and surgeries – and on to that day in the fall of 2009, when the team in Minnesota agreed to pursue a pilot project, to discussing a federal nomination with the committee member, to providing comments to the federal advisory committee and participating in this federal workgroup that yielded this report..it’s been a whirlwind.  Now, all this news coverage in the past 24 hours.  It’s clear the time has come to use all the tools available to support the early detection of heart defects in newborns.

http://www.cbsnews.com/video/watch/?id=7377689n&tag=mg;earlyshow

http://articles.latimes.com/2011/aug/21/health/la-he-heart-screening-20110822

http://www.webmd.com/parenting/baby/news/20110819/blood-oxygen-test-finds-heart-defects-in-newborns

http://www.medscape.com/viewarticle/748382

http://www.baltimoresun.com/health/boostershots/la-he-heart-screening-20110822,0,1119997.story

http://seattletimes.nwsource.com/html/health/2015978538_webheart22.html

http://www.smartplanet.com/blog/rethinking-healthcare/could-a-new-screening-help-identify-heart-problems-for-newborns/6335

http://health.usnews.com/health-news/family-health/heart/articles/2011/08/22/steps-outlined-to-screen-all-newborns-for-heart-defects

http://blogs.wsj.com/health/2011/08/22/screening-newborns-for-congenital-heart-disease/?mod=WSJBlog