A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units

Alice Gong; Charleta Guillory; Liza Creel; Judith Ellen Livingtson; Tiffany M. McKee-Garrett; Regine Fortunov

doi:10.1055/s-0037-1599053

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2017; 34(09): 839-844
DOI: 10.1055/s-0037-1599053

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units

Alice Gong

¹Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas

,

Charleta Guillory

²Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

,

Liza Creel

³Department of Health Management and Systems Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky

,

Judith Ellen Livingtson

¹Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas

,

Tiffany M. McKee-Garrett

²Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

,

Regine Fortunov

²Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

› Institutsangaben

Abstract

Objective The objective of this study was to implement a strategy for critical congenital heart disease (CCHD) newborn screening in the neonatal intensive care unit (NICU).

Design A NICU-specific curriculum, screening algorithm, slide presentations, and templates of orders, policies, and procedures were developed into a toolkit for training NICU personnel. Screening was conducted on first and second screen pre- and postductal oxygen saturations (SpO₂) on newborns admitted or transferred to the NICU.

Results We trained 347 NICU personnel in 13 Texas hospitals, representing rural, suburban, and metropolitan settings. Key hospital staff submitted deidentified, case-based screening data. Of 4,621 NICU admissions, 80% received a first screen. Second screening rates were substantially lower in all gestational age groups. Screening rates on first and second screens were lowest among infants born < 28 weeks. For the first screen, SpO₂ was lowest among the youngest gestational ages. The false positive rate was 2.3%.

Conclusion CCHD screening in the NICU is challenging, given the complexities of the NICU population. A modified screening protocol that recognizes special circumstances of neonatal intensive care could facilitate a more efficient system.

Keywords

critical congenital heart disease - NICU - newborn screening - multicenter

Volltext

Referenzen

References
1 de-Wahl Granelli A, Wennergren M, Sandberg K. , et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ 2009; 338: a3037 . Doi: 10.1136/bmj.a3037
2 Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 2012; 379 (9835): 2459-2464
3 Mahle WT, Newburger JW, Matherne GP. , et al; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research; American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, and Committee on Fetus and Newborn. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120 (05) 447-458
4 Secretary's Advisory Committee on Heritable Disorders in Newborns and Children. . Washington, DC: U.S. Department of Health and Human Services. Available at: http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders/ recommendations/correspondence/cyanoticheartsecre09212011.pdf . Accessed 2011
5 Association of State and Territorial Health Officials. Critical congenital heart disease legislative tracking map. Available at: http://www.astho.org/public-policy/state-health-policy/newborn-screening-heart-defects-map . Accessed 2015
6 Manja V, Mathew B, Carrion V, Lakshminrusimha S. Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit. J Perinatol 2015; 35 (01) 67-71
7 Iyengar H, Kumar P, Kumar P. Pulse-oximetry screening to detect critical congenital heart disease in the neonatal intensive care unit. Pediatr Cardiol 2014; 35 (03) 406-410
8 Goetz EM, Magnuson KM, Eickhoff JC, Porte MA, Hokanson JS. Pulse oximetry screening for critical congenital heart disease in the neonatal intensive care unit. J Perinatol 2016; 36 (01) 52-56
9 Hu XJ, Zhao QM, Ma XJ. , et al. Pulse oximetry could significantly enhance the early detection of critical congenital heart disease in neonatal intensive care units. Acta Paediatr 2016; 105 (11) e499-e505
10 Farner R, Livingston J, Rubio SA, Gutierrez MV, Gong A. ; Texas Pulse Oximetry Project Team. The nurse champion model for advancing newborn screening of critical congenital heart disease. J Obstet Gynecol Neonatal Nurs 2014; 43 (04) 497-506
11 Kemper AR, Mahle WT, Martin GR. , et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128 (05) e1259-e1267
12 StataCorp; Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013
13 Manja V, Lakshminrusimha S, Cook DJ. Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis. JAMA Pediatr 2015; 169 (04) 332-340
14 American Academy of Pediatrics. Newborn screening for CCHD, topic 4, screening in special settings. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/PEHDIC/Pages/Newborn-Screening-for-CCHD.aspx . Accessed 2016
15 Oster ME, Aucott SW, Glidewell J. , et al. Lessons learned from newborn screening for critical congenital heart defects. Pediatrics 2016; 137 (05) e20154573 . Doi: 10.1542/peds.2015-4573