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The Performance of Critical Congenital Heart Disease Screening in Rural Versus Urban Locations in the Northwest
Brian S Marcus1,2, Plicy Perez-Kersey3,4, Ann B Lee3
1Department of Pediatrics, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI.
Insights
Newborns in rural areas are more likely to be diagnosed with critical congenital heart disease (CCHD) after birth. Pulse oximetry screening is vital for early CCHD detection, particularly in rural settings and hospitals with lower nursery levels.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Pulse oximetry screening effectively detects critical congenital heart disease (CCHD) in newborns.
- Rural birth locations may influence the timing and management of surgical interventions for infants with congenital heart disease (CHD).
- The association between rurality and CCHD screening outcomes remains largely unexplored.
Purpose of the Study:
- To investigate the relationship between rural birth location and postnatal diagnosis of CCHD.
- To describe lesion-specific diagnostic methods for CCHD.
- To evaluate the impact of rurality on CCHD diagnosis rates and screening effectiveness.
Main Methods:
- Retrospective data abstraction from medical records at two Washington state cardiac surgery centers.
- Inclusion of infants diagnosed with CCHD (requiring intervention or resulting in death <1 month) born between July 2015 and June 2020.
- Classification of diagnosis method and determination of rural location using patient ZIP codes.
Main Results:
- Out of 561 newborns with CCHD, 35% were diagnosed postnatally.
- Postnatal diagnosis rates increased with rurality (48% in rural vs. 32% in urban areas; P=.01).
- Incidence of undiagnosed CCHD at birth rose with lower nursery levels, indicating disparities in care.
Conclusions:
- CCHD screening identifies a significant portion of postnatally diagnosed cases (22%) and overall cases (7%).
- Postnatal diagnosis of CCHD is more prevalent in rural regions, highlighting potential screening gaps.
- The findings underscore the importance of CCHD screening in routine newborn care, especially in rural areas and facilities with lower nursery levels.
Objectives:
Pulse oximetry screening of newborns detects critical congenital heart disease (CCHD). Rural birth location is known to affect timing and management of when infants with CHD undergo surgery, but its association with CCHD screening is unknown. We assess the relationship between rural location and postnatal CCHD diagnosis and describe lesion-specific modes of diagnosis.
Study Design:
Data were abstracted from medical records at 2 cardiac surgery centers in Washington state. Infants with CCHD, defined as CHD requiring either cardiac intervention or resulting in death at <1 month of age, born between July 2015 and June 2020, were included and classified by method of identification. Patient home ZIP codes were used to determine rural location.
Results:
We included 561 newborns with CCHD; 35% were diagnosed postnatally. Predominant postnatal mechanisms of identification (n = 194) included symptomatic before CCHD screening period (56%), CCHD screening (22%), and symptomatic after false-negative screen (15%). Postnatal diagnosis rate increased with degree of ruralness (48% in small rural/isolated regions vs 32% in urban regions; P = .01) and incidence of undiagnosed CCHD at birth increased with lower nursery levels (5.5/10 000 live births in nursery level 1 vs 2.1/10 000 live births in level 4).
Conclusions:
CCHD screening identifies 22% of postnatally diagnosed CCHD and 7% of cases overall in our region. Postnatal diagnosis is more common in rural regions. The incidence of undiagnosed CCHD at birth increases with decreasing nursery levels. This study supports the value of CCHD screening in routine newborn care, especially in rural areas and hospitals with lower nursery levels.
