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Assessment of current practices and feasibility of routine screening for critical congenital heart defects - Georgia,
Insights
Many Georgia hospitals are screening newborns for critical congenital heart defects (CCHD) using pulse oximetry. However, inconsistent protocols and lack of follow-up plans hinder widespread, standardized CCHD screening.
Area of Science:
- Public Health
- Neonatal Screening
- Cardiology
Background:
- The U.S. recommended adding critical congenital heart defects (CCHD) to newborn screening panels in 2011.
- Anecdotal evidence suggested some Georgia hospitals were implementing CCHD screening using pulse oximetry by 2012.
- Understanding the adoption, practices, and challenges of CCHD screening in Georgia was needed.
Purpose of the Study:
- To assess the prevalence of routine CCHD screening in Georgia birthing hospitals.
- To identify specific CCHD screening practices and variations among hospitals.
- To determine barriers to implementing CCHD screening in Georgia hospitals.
Main Methods:
- Two surveys were administered to Georgia birthing hospitals in June 2012 by the CDC and Georgia DPH.
- The initial survey targeted 89 hospitals to gauge screening prevalence and planned implementation.
- Eleven pulse oximetry screenings were observed across five hospitals to estimate screening duration.
Main Results:
- Of 71 responding hospitals, 31% were actively screening for CCHD, and 28% planned to start in 2012.
- Key barriers included unclear follow-up protocols for positive screens, reporting uncertainties, and cost concerns.
- Only one-third of screening hospitals adhered to the American Academy of Pediatrics protocol; others varied in timing and criteria.
Conclusions:
- Routine CCHD screening has commenced in many Georgia hospitals without a state mandate.
- Standardizing CCHD screening protocols is crucial to reduce practice variations.
- Collaborative agreements are necessary to ensure access to echocardiography and follow-up care for newborns with suspected CCHD.
Abstract:
In September 2011, the U.S. Secretary of Health and Human Services recommended that critical congenital heart defects (CCHD) be added to the Recommended Uniform Screening Panel (RUSP) for newborns. Anecdotal reports in early 2012 suggested that some Georgia hospitals had begun screening for CCHD using pulse oximetry. To better understand the prevalence of routine CCHD screening, specific practices among screening hospitals, and barriers to screening among all birthing hospitals in the state, CDC and the Georgia Department of Public Health (DPH) conducted two surveys of Georgia hospitals in June 2012. Eleven pulse oximetry screenings at five hospitals also were observed to estimate screening time. The initial survey was sent to 89 birthing hospitals, among which 71 (80%) responded; 22 (31%) reported currently screening for CCHD and 20 (28%) planned to start in 2012. Barriers to screening included lack of a clear follow-up protocol for positive screening tests, uncertainty about reporting screening results to public health organizations, and cost concerns. Sixteen (73%) currently screening hospitals responded to the second survey. Only one third of screening hospitals followed the CCHD screening protocol endorsed by the American Academy of Pediatrics; the remaining hospitals screened at different times or had different criteria for a positive screen. Screening time averaged 10 minutes per newborn. In the absence of a state mandate, routine screening has begun in many Georgia hospitals. Use of a standardized screening protocol for CCHD could reduce current variation in screening practices among Georgia hospitals. Working agreements between hospitals also are needed to ensure access to echocardiography and follow-up of newborns with possible CCHD.
