COMMENTARY

Does Screening Newborns for Congenital Heart Disease Save Lives?

William T. Basco, Jr, MD, MS

Disclosures

May 31, 2018

Newborn Screening for Congenital Heart Disease

Congenital heart disease is present in approximately 800 per 100,000 births, and approximately one fourth of these infants (200 per 100,000 births) are considered to have critical congenital heart disease (CCHD). To detect these critical cardiac malformations, many states have instituted universal pulse oximetry screening in the newborn nursery at approximately 24 hours of life. States have gradually adopted this practice, but the implementation has been staggered.

To assess the potential real-world effectiveness of pulse oximetry screening for CCHD, a recent study[1] reviewed screening policies in place during calendar years 2011-2013 and compared death rates from CCHD in states that had implemented screening with those in states that had not. Using data from the National Center for Health Statistics, Centers for Disease Control and Prevention, each birth was classified as "exposed" to screening (born during months after which states were known to have enacted screening), exposed to nonmandatory screening (born during months in which states had adopted a policy but may not have fully implemented screening), or not exposed.

Ultimately, data were compared from eight states that had implemented mandatory CCHD screening, five states that had adopted nonmandatory screening policies, and nine states that had adopted mandatory policies but had not yet enacted the mandates.

Study Findings

Nationally, during 2007-2012, there was a small background reduction in deaths due to CCHD of 2.8% per year. However, this trend was not seen in the states that later implemented mandatory critical CCHD screening.

After full adjustment, there was a 33.4% reduction in CCHD deaths (95% confidence interval,10.6%-50.3%) in states that had implemented mandatory screening (an absolute reduction of 3.9 deaths per 100,000 births.)

There was no statistical difference in CCHD deaths all variables between states that had adopted nonmandatory policies versus states with no policies were controlled for. However, statewide implementation of mandatory policies for newborn screening for CCHD was associated with significant reductions in infant cardiac death compared with states that had no mandatory policies.

Viewpoint

These data support universal CCHD screening, and I expect give comfort to providers and neonatal staff members who may have been skeptical of implementing these programs. It certainly was not easy, but many providers now have anecdotal stories of infants identified early who might have otherwise been discharged with unknown CCHD. Hopefully, with time, additional epidemiologic data such as these may help us refine screening and overcome barriers to its implementation.

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