NEW YORK (Reuters Health) – A specially convened work group has concluded that routine screening of newborns for critical congenital heart disease, based on the detection of low oxygen saturation via pulse-oximetry monitoring, should begin,. In its report in the November issue of Pediatrics, the panel also recognizes the challenges of implementing a new screening program and outlines strategies for doing so.
Dr. Alex R. Kemper, with the Duke Clinical Research Institute in Durham, North Carolina, and colleagues explain that an advisory committee in 2010 recommended screening for critical congenital cyanotic heart disease be added to the uniform screening panel for newborns. The Secretary of the US Department of Health and Human Services, however, did not endorse the recommendation to begin screening, in part because of questions about implement the program.
A work group was convened to outline implementation strategies, which are summarized in the current report.
The panel chose to focus on screening in the well-infant nursery, because of the risk of missing congenital heart disease in seemingly healthy infants.
Screening should not be undertaken before 24 hours after birth, if possible, because earlier screening can lead to false-positive findings, the authors advise, and they provide an algorithm for a recommended screening protocol. “The algorithm cutoffs may need to be adjusted in high-altitude nurseries,” they note.
A positive screening result requires a comprehensive evaluation, and in the absence of other findings, an echocardiogram should be obtained and interpreted by a pediatric cardiologist, the work group emphasized.
“Because of the importance of quickly establishing the diagnosis of CCHD (critical congenital heart disease), the work group recommended that hospitals and birthing centers establish a protocol to ensure timely evaluation, including echocardiograms and any necessary subsequent follow-up, before instituting a CCHD screening program,” according to the report.
The document outlines costs of screening and implications for staffing, and the need for education for health care providers and for families on the rationale of pulse-oximetry monitoring to detect critical congenital heart disease.
Summing up, the work group concludes: “To ensure that screening is implemented in a safe and effective manner, the work group strongly endorsed the development and funding of a national technical assistance center to disseminate best practices; to partner with public health agencies to monitor the impact of screening; to evaluate and make recommendations regarding workforce and related infrastructure needs; and to coordinate research to help answer the important unanswered questions regarding screening thresholds and optimal strategies for diagnosis and follow-up.”
Reference:
Strategies outlined for neonatal screening for congenital heart disease
Pediatrics 2011;128.
