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Newborn congenital heart defect screening burden low, requires consistency
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Research published in Morbidity and Mortality Weekly Report suggests a need for data collection and reporting of universal critical congenital heart defects.
Rapid implementation in New Jersey
A statewide screening protocol for critical congenital heart defects in newborns initiated in New Jersey posed a relatively low burden to hospitals.
New Jersey implemented a statewide newborn screening protocol using pulse oximetry in August 2011. In January 2012, the CDC assisted with assessment of the implementation and studied a sample of 11 of the 52 birthing facilities in New Jersey. All 11 facilities were screening for critical congenital heart defects.
Based on pulse oximetry screening data, 98.2% of 25,214 newborns were screened, based on pulse oximetry data. Of those, 12 newborns had positive screening results and two were newly diagnosed with critical congenital heart defects.
“Because of state-specific factors, such as out-of-state referral patterns, these findings might underestimate the anticipated number of positive screens in states with varying referral patterns and use of prenatal diagnosis,” Jill Glidewell, MSN, MPH, EIS officer at the CDC, and colleagues wrote.
Jill Glidewell
In addition, staff interviews were conducted to assess screening processes, data collection and flow, electronic medical record capabilities, and reporting of data. Three of the 11 birthing facilities electronically entered and maintained data into an electronic medical record, five manually entered and maintained data in paper charts and logs, and three used both electronic and manual methods.
Based on questionnaire responses, hospital staff reported that the newly mandated screening process posed minimal burden (average score: 2.1; range from 1 [no burden] to 10 [very burdensome]).
Standardizing to improve outcomes
A statewide screening protocol for critical congenital heart defects in newborns initiated in New Jersey posed minimal burden, whereas standardizing the screening protocol in Georgia hospitals could reduce incomplete screening outcomes, according to research published in Morbidity and Mortality Weekly Report.
Georgia hospitals began screening for critical congenital heart defects with pulse oximetry in early 2012 at the recommendation of the Department of Health and Human Services. By June 2012, the CDC and the Georgia Department of Public Health conducted two surveys of Georgia birthing hospitals to determine the prevalence and barriers of routine screening. Eleven pulse oximetry screenings at five hospitals were also observed to estimate screening time.
Of 89 hospitals surveyed, 71 responded to the first survey. According to the responses, 22 hospitals reported currently screening for critical congenital heart defects in the well-baby nursery; 20 planned to start screening in 2012.
Barriers to screening included lack of a clear follow-up protocol for positive screening tests, cost concerns and uncertainty about reporting results to public health organizations.
Sixteen of the 22 hospitals that reported screening responded to the second survey. Only one-third reported following the critical congenital heart defect screening protocol endorsed by the American Academy of Pediatrics; the remaining hospitals screened at different times or used different criteria for a positive screen. Average screen time was 10 minutes for newborn. In other results, no hospitals provided screening documentation to parents, 12 did not know how often to send screening data to the Georgia Department of Public Health and 11 were uncertain of which data to submit. Extra staff or extra staff hours were not added to accommodate screening in 13 hospitals. Four of 16 hospitals identified one or more infants with critical congenital heart defects through screening.
“Use of a standardized screening protocol for critical congenital heart defects could reduce current variation in screening practices among Georgia hospitals. Working agreements between hospitals also are needed to ensure access to echocardiography and follow-up of newborns with possible critical congenital heart defects,” Pamela Clark, MSN, of the Georgia Department of Public Health, and fellow researchers wrote in MMWR.
For more information:
Clark P. MMWR. 2013;62:288-291.
Garg LF. MMWR. 2013;62:292-294.