Impact of Newborn CCHD Screening Using Pulse Oximetry in the United States

Critical congenital heart disease (CCHD) screening using pulse oximetry was mandated by all states between 2011-2018. We sought to evaluate the effect on the age at initial admission to a children's hospital, the hospital length of stay (LOS), and in-hospital mortality before and after pulse oximetry screening (POS) mandates. A multicenter retrospective cohort study of the Pediatric Health Information System was performed evaluating neonates with CCHD born at ≥34 weeks gestation admitted to a children's hospital after the first day of life. We evaluated changes before and after POS mandates in mean age at initial admission and LOS using interrupted time series (ITS) analysis to identify post-POS mandate level and trend changes. There was inadequate power to analyze in-hospital mortality rates with ITS or logistic regression. 12,298 neonates were included from 39 children's hospitals in 22 states and District of Columbia. After POS mandates, neonates tended to be admitted to children's hospitals earlier, with decreases in level (2.2 days; p<0.001) and trend (annual change: +5% to no change; p=0.03). Post-mandate neonates had longer mean LOS with a level increase of 6 days (p=0.03) and no significant change in trend. Descriptive data showed in-hospital mortality decreased from 7.5% pre-mandate to 6.6% post mandate across the cohort, but could not be further evaluated using ITS modeling. Subgroup analyses with only high sensitivity diagnoses and excluding outflow tract diagnoses yielded similar findings. POS mandates were associated with earlier age of initial admission to a children's hospital and increased hospital LOS.