CCHD screening for infants proves successful in New Jersey

CCHD screening for infants proves sucessful in New Jersey
CCHD screening for infants proves sucessful in New Jersey

Critical congenital heart disease (CCHD) screening in New Jersey has led to the detection of heart disorders in several babies, potentially saving their lives, according to a report in the journal Pediatrics.

“Mandated [screening] successfully identified three infants with previously undetected CCHD who likely would have been discharged from the hospital,” said Lorraine F. Garg, MD, MPH, of the New Jersey Department of Health (NJDOH), and colleagues.

New Jersey was the first state to implement mandatory CCHD screening for newborns. The legislation went into effect on August 31, 2011.

CCHD, including such conditions as hypoplastic left heart syndrome, pulmonary atresia, coarctation of aorta, amongst other defects, affects approximately two infants for every 1,000 live births in the United States. While some cases can be visually detected, pulse oximetry screening (POxS) can sometimes catch cases that otherwise go unnoticed.

The test is done by using a sensor to measure the amount of hemoglobin in blood that is oxygen-saturated, which can indicate the presence of hypoxemia -- a common feature of CCHD. The noninvasive test is typically performed by passing light waves through a patient from a sensor attached to the fingertip.

Screening in both the right hand and either foot is mandated for all live births in New Jersey after 24 hours of age and ideally before discharge, regardless of the infant's health status, prenatal diagnosis of CCHD, and location.

The study collected data from New Jersey birthing facilities during the first nine months after this legislation went into effect (i.e. August 31, 2011 to May 31, 2012). Birthing facilities are required to collect information about screening implementation and results and submit aggregate data every three months.

The study found that 75,324 live births were reported from 53 licensed birthing facilities in New Jersey during the nine month period. Of the 73,320 infants that were eligible for screening, 99.1% received POxS. Reasons for ineligibility included death, a report or transfer occurring before the infant was 24 hours old, and medical conditions that disallowed screening.

Of those screened, 49 infants failed the POxS. Of those 49, 30 did not present with any of the three clinical indicators of CCHD, meaning that they likely would not have been diagnosed had they not been screened. Subsequent evaluations showed that three of the 30 had CCHD, and 17 had other conditions, such as sepsis, pneumonia, and pulmonary hypertension.

The high rates of implementation of POxS and the diagnosis of three infants with otherwise unsuspected CCHD that could have caused significant morbidity and mortality indicate the usefulness of screening and validate New Jersey's decision to make it mandatory.

“The New Jersey experience produced meaningful qualitative and quantitative information for evaluating and improving our program as well as for assisting other states as they begin implementation and evaluation of POxS,” the researchers said.

However, there is still work to be done. Not all eligible infants were screened, which might explain why there were 48 cases of CCHD that were unaccompanied by a failed screening.

“These findings underscore that training and education are needed to emphasize that all infants are required to receive the mandated POxS,” the study wrote.

by Walker Harrison, an undergraduate student at Columbia University and editorial intern with Clinical Advisor.


References

  1. Garg LF et al. Pediatrics doi: 10.1542/peds.2013-0269.
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