Results From the New Jersey Statewide Critical Congenital Heart Defects Screening Program

Abstract

BACKGROUND AND OBJECTIVE New Jersey was the first state to implement legislatively mandated newborn pulse oximetry screening (POxS) in all licensed birthing facilities to detect critical congenital heart defects (CCHDs). The objective of this report was to evaluate implementation of New Jersey’s statewide POxS mandate. METHODS A 2-pronged approach was used to collect data on infants screened in all New Jersey birthing facilities from August 31, 2011, through May 31, 2012. Aggregate screening results were submitted by each birthing facility. Data on failed screens and clinical characteristics of those newborns were reported to the New Jersey Birth Defects Registry (NJBDR). Three indicators were used to distinguish the added value of mandated POxS from standard clinical care: prenatal congenital heart defect diagnosis, cardiology consultation or echocardiogram indicated or performed before PoxS, or clinical findings at the time of POxS warranting a pulse oximetry measurement. RESULTS Of 75 324 live births in licensed New Jersey birthing facilities, 73 320 were eligible for screening, of which 99% were screened. Forty-nine infants with failed POxS were reported to the NJBDR, 30 of whom had diagnostic evaluations solely attributable to the mandated screening. Three of the 30 infants had previously unsuspected CCHDs and 17 had other diagnoses or non-CCHD echocardiogram findings. CONCLUSIONS In the first 9 months after implementation, New Jersey achieved a high statewide screening rate and established surveillance mechanisms to evaluate the unique contribution of POxS. The screening mandate identified 3 infants with previously unsuspected CCHDs that otherwise might have resulted in significant morbidity and mortality and also identified other significant secondary targets such as sepsis and pneumonia.

Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

“…This initial concern was not valid; early adopters did not find that the number of false positives overwhelmed the care delivery system in the way of unnecessary referrals to specialists or unnecessary echocardiograms [33,34]. Screening with pulse oximetry is not diagnostic for CCHD, it simply identifies an infant for follow-up to determine the cause for hypoxia.…”

Age at Referral and Mortality From Critical Congenital Heart Disease

“…33 Our study provides information on the timing of referral of CCHD and its associated mortality (Tables 2 and 3), which may be useful in estimating the required sample size for epidemiologic studies to show an effect of pulse oximeter screening on neonatal CCHD mortality. In addition, future studies should also measure other outcome variables such as length of stay and morbidity, because earlier detection may lead to fewer infants developing cardiac decompensation before referral to a cardiac center.…”

Delayed Diagnosis of Critical Congenital Heart Defects: Trends and Associated Factors

“…Most CCHD definitions include the 7 defects that are considered primary targets for pulse oximetry screening, based on their tendency to result in hypoxemia: hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus. [3][4][5] Many definitions also include some CHDs that do not consistently present with hypoxemia, such as coarctation of the aorta. 3,5,6 Several also incorporate a measure of severity, including a requirement that surgery, catheterization, or death occur within a specified time period, ranging from the first few weeks to the first year of life.…”

“…[3][4][5] Many definitions also include some CHDs that do not consistently present with hypoxemia, such as coarctation of the aorta. 3,5,6 Several also incorporate a measure of severity, including a requirement that surgery, catheterization, or death occur within a specified time period, ranging from the first few weeks to the first year of life. [7][8][9] Although delayed diagnosis of CCHDs has been associated with serious complications, including seizure, cardiac arrest, and death, 7,10,11 few studies have examined temporal trends or factors associated with delayed diagnosis.…”

“…The American Heart Association and the American Academy of Pediatrics have endorsed such screening, 14 and recent studies in US populations suggest that pulse oximetry screening is costeffective and results in lower hospital costs during infancy. 3,11,15 In response, many states, including Massachusetts, have enacted legislation requiring pulse oximetry screening of newborns.…”