AHA.14: N.J.'s mandatory newborn pulse-ox screening shows success

Critical screening for newborns in New Jersey bears fruit: 13 more babies were identified with critical congenital heart defects than had been previously identified through prenatal screening or physical exam. Secondarily, babies with other kinds of congenital heart defects and serious medical conditions were identified solely through the mandatory pulse oximetry program.

In June of 2011, the New Jersey governor, Chris Christie, enacted legislation that required all hospitals and birthing centers in the state to evaluate all live births using noninvasive pulse oximetry screening to determine infant risks for critical congenital heart defects. Data on the program  was presented Nov. 16 at the American Heart Association scientific session 2014 in Chicago.

According to Kim Van Naarden Braun, PhD, of the Centers for Disease Control and Prevention (CDC) in Atlanta, approximately 1 percent of infants have congenital heart defects. Of those, critical congenital heart defects represent 25 percent.

Van Naarden Braun told Cardiovascular Business that the intent of the legislation was to capture the small percentage of newborns who appear healthy at birth and are not identified through prenatal screening or physical exam who may be discharged from the hospital, but need extra care. Van Naarden Braun also serves with the New Jersey Health Department.  

“The screening is a tool that works with prenatal diagnosis and physical exam after birth to improve detection and hopefully intervene early,” Van Naarden Braun said. “If a baby with critical congenital heart defects goes undetected, later detection could result in significant disability or death for the infant. There are significant implications for late diagnosis.”

Since the legislation was enacted, screening was successfully performed on 99.6 percent of live births in the state. Under the initial rollout, hospitals and the health department had to determine screening passes and fails. “The health department worked extremely hard to produce an algorithm to provide to hospitals," Van Naarden Braun said. "The bulk of babies for which no screen had been done were in the first three months after implementation.”

As with any new clinical goal, Van Naarden Braun said, the initial bump involved determining how best to interpret who gets screened and who doesn’t and training hospitals on how best to utilize the data they were getting. Babies in the neonatal intensive care unit were a challenge, simply as a matter of how to report on them as many were already being monitored by pulse oximeter. “We had a lot of conversations as to how to help hospitals who are immersed in clinical care for babies that are already sick make a distinction between clinical assessment--clinical measure with a pulse oximeter--vs. an actual public health screen."

However, Van Naarden Braun noted, “New Jersey hospitals did an amazing job at maintaining screening coverage that was approximately 98 to 99 percent right from the the start of implementation.”

Each patient identified through the newborn screening program is a success story for the state, Van Naarden Braun added. In particular one of the 13 identified critical congenital heart defect babies identified during the first day of screening is today a “precious toddler.” Eleven babies were identified with noncritical congenital heart defects and a further six with other serious medical conditions were identified and aided. However, “because of the screening, they were identified earlier. It’s added success to the screening program.”

Van Naarden Braun did note that, “In New Jersey, we’re starting a study right now to look more specifically at the neonatal intensive care unit (NICU) population and come up with recommendations specific to interpreting and applying oximetry screening to patients in the NICU.” The intent is to provide NICU best practices for hospitals going forward.