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Screening for critical congenital heart disease: advancing detection in the newborn
Elizabeth A Bradshaw1, Gerard R Martin
1Children's National Medical Center, George Washington University School of Medicine, Washington, District of Columbia 20010, USA. ebradsha@childrensnational.org
Insights
Screening for critical congenital heart disease (CCHD) using pulse oximetry is now recommended. This cost-effective screening is easily implemented in hospitals and improves detection rates for newborns.
Area of Science:
- Neonatal health
- Public health screening
- Congenital disease detection
Background:
- Critical congenital heart disease (CCHD) screening via pulse oximetry was added to the uniform screening panel in 2011.
- Professional organizations endorse CCHD screening, providing implementation guidance.
Purpose of the Study:
- To review the implementation and effectiveness of CCHD screening.
- To assess readiness and cost-effectiveness of CCHD screening protocols.
Main Methods:
- Review of professional endorsements and implementation strategies.
- Analysis of hospital readiness and cost-effectiveness data.
Main Results:
- CCHD screening is endorsed by major pediatric and cardiology organizations.
- Screening is cost-effective, requires no additional staff, and improves detection.
- Hospitals generally possess necessary equipment, but CCHD may be missed in neonatal care units.
Conclusions:
- CCHD screening is easily implemented in community hospitals.
- The screening is cost-effective and feasible for many healthcare settings.
- Some states are well-prepared for CCHD screening implementation.
Purpose Of Review:
Screening for critical congenital heart disease (CCHD) using pulse oximetry was added to the recommended uniform screening panel through an endorsement by the Health and Human Services Secretary in September 2011. As organizations on both the macrolevels and microlevels consider implementation, research efforts and professional endorsements have been completed, providing important guidance moving forward.
Recent Findings:
Screening for CCHD has been endorsed by the American Heart Association, American College of Cardiology, March of Dimes and American Academy of Pediatrics. In addition, strategies for best practice regarding implementation and a screening protocol for well babies are now available. Screening for CCHD as a complement to existing mechanisms has been added without need for additional staff, associated with improved detection, and shown to be cost effective with an incremental cost-effectiveness ratio of £24 000. Hospitals in Wisconsin assessed their readiness and reported that all had pulse oximetry equipment onsite and 74.4% had access to same-day neonatal echocardiography. Infants in neonatal care units need further consideration, as there were reports of CCHD missed.
Summary:
CCHD screening is easily implemented in community hospitals, and is cost effective, and some states may be better prepared for implementation than previously hypothesized.
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