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Sakai-Bizmark R, Chang RKR, Martin GR, Hom LA, Marr EH, Ko J, Goff DA, Mena LA, von Kohler C, Bedel LEM, Murillo M, Estevez D, Hays RD. Current Postlaunch Implementation of State Mandates of Newborn Screening for Critical Congenital Heart Disease by Pulse Oximetry in U.S. States and Hospitals. Am J Perinatol 2024; 41:e550-e562. [PMID: 36580978 PMCID: PMC11105930 DOI: 10.1055/s-0042-1756327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/06/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Our objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics. STUDY DESIGN Between March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements. RESULTS Responses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO2 as an immediate failed screen and 31% responded that an infant with SpO2 of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = -1.23 p = 0.01) and early adoption by states (beta = -1.01, p < 0.01). CONCLUSION When presented with SpO2 screening values on a questionnaire, a low percentage of nurse supervisors selected responses that demonstrated adherence to nationally endorsed protocols for CCHD screening. Most notably, almost one-third of respondents did not recognize ≤90% SpO2 as a failed screen that requires immediate physician follow-up. In addition, states without reporting mandates and early adopter states were associated with low policy consistency. Implementing state reporting requirements might increase policy consistency, but some inconsistency may be the result of unique protocols in early adopter states that differ from nationally endorsed protocols. KEY POINTS · Low adherence to nationally endorsed protocols.. · Inconsistent physician follow-up to hypoxia.. · Reporting improved consistency with national policy..
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Affiliation(s)
- Rie Sakai-Bizmark
- Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California
- Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Torrance, California
| | - Ruey-Kang R. Chang
- Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Torrance, California
- Division of Cardiology, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Gerard R. Martin
- Division of Cardiology, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Lisa A. Hom
- Division of Cardiology, Children's National Hospital, the George Washington University School of Medicine, Washington, District of Columbia
| | - Emily H. Marr
- Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Jamie Ko
- Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Torrance, California
- Division of Pediatric Hospital Medicine, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Donna A. Goff
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Laurie A. Mena
- Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Connie von Kohler
- Miller Children's and Women's Hospital Long Beach, MemorialCare Health System, Long Beach, California
| | - Lauren E. M. Bedel
- Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Mary Murillo
- Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Dennys Estevez
- Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Ron D. Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
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Gómez-Gutiérrez R, Galindo-Hayashi JM, Cantú-Reyna C, Vazquez-Cantu DL, Britton-Robles C, Cruz-Camino H. Critical CHD screening programme: a 3-year multicentre experience in Mexico. Cardiol Young 2022; 33:1-7. [PMID: 35801272 DOI: 10.1017/s1047951122001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION CHDs are the most common type of birth defect. One in four newborns with a heart defect has a critical CHD. In Mexico, there is a lack of data available to determine its prevalence. Pulse oximetry screening programmes have been implemented worldwide, reporting opportunity areas in algorithm interpretation and data management. Our study aims to share preliminary results of a 3-year experience of a multicentre pulse oximetry screening programme that addresses critical challenges. MATERIALS AND METHODS This retrospective study examined the reports of newborns screened from February 2016 to July 2019 from five hospitals. Two algorithms -the New Jersey and the American Academy of Pediatrics- were implemented over consecutive periods. The algorithms' impact was assessed through the calculation of the false-positive rate in an eligible population. RESULTS A total of 8960 newborns were eligible for the study; from it, 32.27% were screened under the New Jersey and 67.72% under the American Academy of Pediatrics algorithm - false-positive rate: 1% (CI 95: ± 0.36%) and 0.71% (CI 95: ± 0.21%), respectively. Seventy-nine newborns were referred, six were diagnosed with critical CHD, and six with CHD. The critical CHD estimated prevalence was 6.69:10,000 newborns (CI 95: ± 5.36). Our results showed that the algorithm was not related to the observable false-positive rate reduction. DISCUSSION Other factors may play a role in decreasing the false-positive rate. Our experience implementing this programme was that a systematic screening process led to more confident results, newborn's report interpretation, and follow-up.
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Affiliation(s)
- René Gómez-Gutiérrez
- Genomi-k, Monterrey, Nuevo León, 64060, Mexico
- CHRISTUS Muguerza, Hospital Alta Especialidad, Monterrey, Nuevo León, 64060, Mexico
| | - José M Galindo-Hayashi
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, 64710, Mexico
| | - Consuelo Cantú-Reyna
- Genomi-k, Monterrey, Nuevo León, 64060, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, 64710, Mexico
| | - Diana L Vazquez-Cantu
- Genomi-k, Monterrey, Nuevo León, 64060, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, 64710, Mexico
| | - Cecilia Britton-Robles
- Genomi-k, Monterrey, Nuevo León, 64060, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, 64710, Mexico
| | - Héctor Cruz-Camino
- Genomi-k, Monterrey, Nuevo León, 64060, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, 64710, Mexico
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Decreasing Mortality for STAT 4 and 5 Neonatal Heart Surgeries Concurrent With Improving Prenatal Detection: The Nevada Experience. World J Pediatr Congenit Heart Surg 2022; 13:361-365. [PMID: 35446211 DOI: 10.1177/21501351221087700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Our objective was to investigate whether a relationship existed between our center's STAT 4 and 5 category surgical mortality and general-population prenatal detection rates in Nevada. Methods: We identified patients who underwent STAT 4 and 5 neonatal index cardiovascular surgeries at our center between October 2012 and September 2021. Additionally, we calculated prenatal detection rates for each of the 9 retrospective study years. We used descriptive statistics and nonparametric testing, including the Spearman Rho correlation (R) and the Mann-Whitney U-tests, with a significant P-value set at < .05. Results: We identified 356 patients. We noted a statistically significant increasing trend in prenatal detection percentages (rho = 0.79, P = .01), concurrent with a statistically significant decreasing trend in surgical mortality (rho = -0.82, P = .007). Conclusions: Despite encouraging results, we could not establish a cause-and-effect relationship between concurrent decreased surgical mortality and increased prenatal detection rates for patients undergoing STAT 4 and 5 surgical procedures at our center.
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Affiliation(s)
- William N Evans
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- 20567Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Pediatrics, Division of Pediatric Cardiology, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
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Martin GR, Schwartz BN, Hom LA, Donofrio MT. Lessons Learned from Infants with Late Detection of Critical Congenital Heart Disease. Pediatr Cardiol 2022; 43:580-585. [PMID: 34709442 DOI: 10.1007/s00246-021-02760-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
Late detection of critical congenital heart disease (CCHD) is multifactorial and ill defined. We investigated the results of pulse oximetry screening (POS) and points in the care chain that contribute to delayed detection of CCHD. The medical records of 13 infants with delayed detection at a single pediatric cardiac center between 2013 and 2016 were identified and reviewed. Left heart obstructive lesions were the most common diagnosis (n = 8; 62%) and included coarctation of the aorta (n = 6), interrupted aortic arch with ventricular septal defect (n = 1), and critical aortic stenosis (n = 1). Tetralogy of Fallot (TOF) (n = 2), truncus arteriosus (n = 1), pulmonary atresia with ventricular septal defect (n = 1), and total anomalous pulmonary venous drainage (n = 1) made up the remainder of the conditions. Routine prenatal care was reported in most infants (10/13). Infants with late detection had either a true negative POS (10/13 infants) or no POS performed (3/13 infants). At the time of detection, 5/6 (83%) infants with coarctation had normal pulse oximetry values, whereas 6/7 (86%) infants with other CCHD developed abnormal pulse oximetry values. At diagnosis, 11/13 (85%) infants had significant signs or symptoms of clinical deterioration; only 2 infants were completely asymptomatic. Late detection of CCHD is uncommon and multifactorial. Eliminating late detection is dependent upon improving detection on screening obstetrical ultrasounds, enforcement of universal POS, and attention to the neonatal physical exam.
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Affiliation(s)
- Gerard R Martin
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA.
- The George Washington School of Medicine, Washington, D.C., USA.
| | - Bryanna N Schwartz
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA
- The George Washington School of Medicine, Washington, D.C., USA
| | - Lisa A Hom
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA
- The George Washington School of Medicine, Washington, D.C., USA
| | - Mary T Donofrio
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA
- The George Washington School of Medicine, Washington, D.C., USA
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Prenatal diagnosis in Nevada for patients undergoing cardiovascular surgery in the first six months. J Card Surg 2021; 36:4472-4475. [PMID: 34486772 DOI: 10.1111/jocs.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We reviewed our center's experience with prenatal detection in Nevada's general population for young infants undergoing cardiovascular surgery. METHODS We identified patients born in Nevada that underwent an initial cardiovascular surgery between 0 and 6 months old with birth dates between August 2012 and July 2021. Additionally, we calculated prenatal congenital cardiovascular malformation detection rates for each of the 9 years. RESULTS We identified 660 patients. For the 660 patients, 649 (98%) mothers underwent prenatal care, which included at least one anatomical-survey obstetric ultrasound. Of the 649 with prenatal care, 395 (61%) had a prenatal diagnosis overall. However, prenatal diagnosis improved over the 9 years from 44% in 2012 to 79% in 2021 (correlation coefficient of 0.93, p = .00024). CONCLUSIONS Our results demonstrated a progressive rise in prenatal detection rates for young infants undergoing cardiovascular surgery in Nevada.
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Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Martin GR, Ewer AK, Gaviglio A, Hom LA, Saarinen A, Sontag M, Burns KM, Kemper AR, Oster ME. Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatrics 2020; 146:peds.2019-1650. [PMID: 32499387 DOI: 10.1542/peds.2019-1650] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/24/2022] Open
Abstract
Seven years after its addition to the US Recommended Uniform Screening Panel, newborn screening for critical congenital heart disease (CCHD) using pulse oximetry became mandatory in the United States. Although CCHD newborn screening reduces morbidity and mortality, there remain important opportunities to improve. An expert panel convened for a 1-day meeting in September 2018, including subject matter experts and representatives from stakeholder organizations. Presentations on CCHD outcomes, variations in approach to screening, and data and quality improvement helped identify improvement opportunities. The expert panel concluded that sufficient evidence exists to recommend modifying the current American Academy of Pediatrics algorithm by (1) requiring an oxygen saturation of at least 95% in both (formerly either) the upper and lower extremities to pass and (2) requiring only 1 repeat screen instead of 2 for cases that neither pass nor fail initially. The panel underscored the importance of improving public health reporting by further specifying the targets of screening and criteria for reporting outcomes (false-negative and false-positive cases). The panel also highlighted the need to ensure sufficient public health funding for CCHD newborn screening and opportunities for education and global implementation. Newborn screening for CCHD using pulse oximetry has led to significant improvements in child health outcomes. However, further important work is required to understand and improve the effectiveness and efficiency of screening.
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Affiliation(s)
- Gerard R Martin
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia;
| | - Andrew K Ewer
- School of Medicine, The George Washington University, Washington, District of Columbia
| | - Amy Gaviglio
- Newborn Screening Program, Minnesota Department of Health, St Paul, Minnesota
| | - Lisa A Hom
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia
| | | | - Marci Sontag
- Center for Public Health Innovation, CI International, Littleton, Colorado
| | - Kristin M Burns
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia.,School of Medicine, The George Washington University, Washington, District of Columbia.,National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alex R Kemper
- Division of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Matthew E Oster
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Rothman A, Galindo A. Detecting Critical Congenital Heart Disease in Nevada. World J Pediatr Congenit Heart Surg 2019; 10:702-706. [DOI: 10.1177/2150135119873847] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: We reviewed data on patients born with critical congenital heart disease in the state of Nevada and analyzed detection via prenatal diagnosis versus newborn pulse oximetry screening, location of birth, and gestational age at birth. Methods: We inquired our databases and electronic health records for all patients with critical congenital heart disease born in Nevada between January 2016 and May 2019. Results: We identified 218 live born patients. Of the 218, average gestational age was 38 weeks (±2.2 weeks). Of the 218, 171 (78%) were prenatally diagnosed, 37 (17%) were diagnosed by immediate postnatal signs and symptoms, 8 (4%) had false-negative pulse oximetry screens that resulted in post-hospital discharge presentations, and 2 (1%) had positive pulse oximetry screens. The eight post-hospital discharge presentations included four in extremis, two with extreme cyanosis, and two dying at home. Of the 171 prenatally diagnosed patients, 157 (92%) were born at the Nevada hospital with the congenital cardiac unit. Conclusion: To the best of our knowledge, our results represent the highest statewide, general population prenatal detection of critical congenital heart disease in the United States. Our high prenatal detection rate led to the majority of patients being born at the Nevada facility with the congenital heart unit, limiting intrastate neonatal transports. On average, patients were born at term. Further, in Nevada, state-mandated, universal pulse oximetry screening resulted in more false-negative results than positive results
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Affiliation(s)
- William N. Evans
- Children’s Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada, Las Vegas School of Medicine, NV, USA
| | - Ruben J. Acherman
- Children’s Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada, Las Vegas School of Medicine, NV, USA
| | - Michael L. Ciccolo
- Children’s Heart Center Nevada, Las Vegas, NV, USA
- Department of Surgery, University of Nevada, Las Vegas School of Medicine, NV, USA
| | - Juan Lehoux
- Children’s Heart Center Nevada, Las Vegas, NV, USA
| | - Abraham Rothman
- Children’s Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada, Las Vegas School of Medicine, NV, USA
| | - Alvarao Galindo
- Children’s Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada, Las Vegas School of Medicine, NV, USA
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Choi EK, Shin JH, Jang GY, Choi BM. Clinical Features of Critical Congenital Heart Disease in Term Infants with Hypoxemia: A Single-Center Study in Korea. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.4.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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