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Development of a Newborn Screening Program for Critical Congenital Heart Disease (CCHD) in Taipei
Pei-Chen Tsao1,2,3,4, Yu-Shih Shiau5, Szu-Hui Chiang5
1Division of General Pediatrics, Pediatrics Department, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Implementing community-based newborn screening for critical congenital heart disease (CCHD) in Taipei proved feasible. This program effectively detected CCHD cases, demonstrating a successful model for early intervention and reduced infant mortality.
Area of Science:
- Neonatal Medicine
- Public Health
- Pediatric Cardiology
Background:
- Critical congenital heart disease (CCHD) poses significant risks to newborns.
- Early detection of CCHD is crucial for reducing infant morbidity and mortality.
Purpose of the Study:
- To assess the feasibility of a community-based newborn CCHD screening program in Taipei.
- To evaluate the effectiveness of pulse oximetry for CCHD detection in a real-world setting.
Main Methods:
- A 6-month trial involving 12 birthing facilities in Taipei.
- Newborns underwent pulse oximetry screening between 24-36 hours of age.
- Defined screening pass/fail criteria and public health nurse follow-up protocols were used.
Main Results:
- High coverage rate (98.6%) achieved with 6,296 newborns screened.
- 16 newborns (0.25%) failed screening; 5 were confirmed with CCHD.
- Two CCHD cases were diagnosed solely due to the screening, with a false-positive rate of 0.18%.
Conclusions:
- The program successfully integrated screening, referral, and public health tracking.
- The developed protocol offers a viable community-based model for global CCHD screening implementation.
Background:
Early detection of critical congenital heart disease (CCHD) can significantly reduce morbidity and mortality among newborns. We investigate the feasibility of implementing a community-based newborn CCHD screening program in Taipei.
Methods:
Twelve birthing facilities in Taipei participated in a trial screening program between October 1, 2013, and March 31, 2014. Newborns underwent pulse oximetry at 24-36 h old, with probes attached to the right hand and one lower limb. Any screening saturation ≥95% in either extremity, with an absolute difference of ≤3% between the right hand and foot, was accepted as a screening pass. A screening result was considered as a fail if the oxygen saturation was <95% at either probe site, on 3 separate occasions, each separated by 30 min or the first result was <95% at either probe site, and any subsequent oxygen saturation measurement was <90%. Public health nurses would follow up all missed or refused cases.
Results:
Of the 6,387 live births, 6,296 newborns (coverage rate: 6,296/6,387 = 98.6%) underwent appropriate pulse oximetry screening. Sixteen newborns (0.25%) were reported to have a failed screening result. Five of these screen positive newborns were confirmed with CCHD; two of them were diagnosed solely attributed to the failed screening results. The false-positive rate was 0.18%. Implementing a 6-month screening program for CCHD produced good case detection rate, while using efficient screening and referral systems.
Conclusion:
This program was successful in integrating screening, referral and public health tracking systems. The protocol outlined in this report could provide a community-based model for worldwide implementation.
