A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units
07 September 2016
09 January 2017
17 February 2017 (online)
Objective The objective of this study was to implement a strategy for critical congenital heart disease (CCHD) newborn screening in the neonatal intensive care unit (NICU).
Design A NICU-specific curriculum, screening algorithm, slide presentations, and templates of orders, policies, and procedures were developed into a toolkit for training NICU personnel. Screening was conducted on first and second screen pre- and postductal oxygen saturations (SpO2) on newborns admitted or transferred to the NICU.
Results We trained 347 NICU personnel in 13 Texas hospitals, representing rural, suburban, and metropolitan settings. Key hospital staff submitted deidentified, case-based screening data. Of 4,621 NICU admissions, 80% received a first screen. Second screening rates were substantially lower in all gestational age groups. Screening rates on first and second screens were lowest among infants born < 28 weeks. For the first screen, SpO2 was lowest among the youngest gestational ages. The false positive rate was 2.3%.
Conclusion CCHD screening in the NICU is challenging, given the complexities of the NICU population. A modified screening protocol that recognizes special circumstances of neonatal intensive care could facilitate a more efficient system.
- 1 de-Wahl Granelli A, Wennergren M, Sandberg K. , et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ 2009; 338: a3037 . Doi: 10.1136/bmj.a3037
- 2 Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 2012; 379 (9835): 2459-2464
- 3 Mahle WT, Newburger JW, Matherne GP. , et al; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research; American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, and Committee on Fetus and Newborn. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120 (05) 447-458
- 4 Secretary's Advisory Committee on Heritable Disorders in Newborns and Children. . Washington, DC: U.S. Department of Health and Human Services. Available at: http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders/ recommendations/correspondence/cyanoticheartsecre09212011.pdf . Accessed 2011
- 5 Association of State and Territorial Health Officials. Critical congenital heart disease legislative tracking map. Available at: http://www.astho.org/public-policy/state-health-policy/newborn-screening-heart-defects-map . Accessed 2015
- 6 Manja V, Mathew B, Carrion V, Lakshminrusimha S. Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit. J Perinatol 2015; 35 (01) 67-71
- 7 Iyengar H, Kumar P, Kumar P. Pulse-oximetry screening to detect critical congenital heart disease in the neonatal intensive care unit. Pediatr Cardiol 2014; 35 (03) 406-410
- 8 Goetz EM, Magnuson KM, Eickhoff JC, Porte MA, Hokanson JS. Pulse oximetry screening for critical congenital heart disease in the neonatal intensive care unit. J Perinatol 2016; 36 (01) 52-56
- 9 Hu XJ, Zhao QM, Ma XJ. , et al. Pulse oximetry could significantly enhance the early detection of critical congenital heart disease in neonatal intensive care units. Acta Paediatr 2016; 105 (11) e499-e505
- 10 Farner R, Livingston J, Rubio SA, Gutierrez MV, Gong A. ; Texas Pulse Oximetry Project Team. The nurse champion model for advancing newborn screening of critical congenital heart disease. J Obstet Gynecol Neonatal Nurs 2014; 43 (04) 497-506
- 11 Kemper AR, Mahle WT, Martin GR. , et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128 (05) e1259-e1267
- 12 StataCorp; Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013
- 13 Manja V, Lakshminrusimha S, Cook DJ. Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis. JAMA Pediatr 2015; 169 (04) 332-340
- 14 American Academy of Pediatrics. Newborn screening for CCHD, topic 4, screening in special settings. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/PEHDIC/Pages/Newborn-Screening-for-CCHD.aspx . Accessed 2016
- 15 Oster ME, Aucott SW, Glidewell J. , et al. Lessons learned from newborn screening for critical congenital heart defects. Pediatrics 2016; 137 (05) e20154573 . Doi: 10.1542/peds.2015-4573