BACKGROUND AND PURPOSE:

• Congenital heart disease (CHD) is responsible for 6% of infant deaths in the US (1999-2006 data)
• Critical CHD is associated with hypoxemia and therefore amenable to screening using pulse oximetry, usually 24 hours following delivery
• Screening for critical CHD is associated with low false positive rates (0.05%)
• In 2011, critical CHD was added to the US Recommended Uniform Screening Panel for newborns
• Abouk et al. (JAMA, 2017) sought to determine the association between implementation of state newborn screening policies for critical CHD and infant death rates

METHODS:

• Observational study
• Compared deaths related to critical CHD before and after policy implementation
• Data was compared between 8 states with mandatory screening policies, 5 states with voluntary screening, and 9 states which had not yet implemented mandates
• Primary outcome was number of early infant deaths coded for critical CHD or other/unspecified congenital cardiac causes for each state-month birth cohort

RESULTS:

• After states implemented mandatory screening, early infant deaths from critical CHD decreased by 33.4% (95% CI, 10.6%-50.3%), with an absolute decline of 3.9 (95% CI, 3.6-4.1) deaths per 100,000
• Early infant deaths from critical congenital heart disease in the first 24 hours was 30.7%
  • Smaller relative reduction in deaths during the first 24 hours or life represents the fact that screening at 24 hours cannot impact deaths prior to that time
• Early infant deaths from other/unspecified cardiac causes declined by 21.4% (95% CI, 6.9%-33.7%), with an absolute decline of 3.5 (95% CI, 3.2-3.8) deaths per 100 000 births
• In 6 states that implemented mandatory policies, significant decrease in deaths due to critical CHD was >50%
  • No significant decrease was seen in states with nonmandatory screening policies

CONCLUSION:

• Almost all states have adopted mandatory policies
• This study provides evidence and validation for the adoption of these public health policies

Learn More – Primary Sources:

Association of US State Implementation of Newborn Screening Policies for Critical Congenital Heart Disease With Early Infant Cardiac Deaths

Related ObG Topics:

Newborn Screening – Responsibilities of the Obstetric Care Provider

Key Points in a Discussion of Newborn Screening Before Delivery

Tetralogy of Fallot- A Critical Congenital Heart Defect