Mandatory Screening Reduces Risk of Infant Death Due to CCHD

Matthew E. Oster, MD

Infant deaths due to critical congenital heart disease (CCHD) were significantly reduced with the adoption of mandatory screening policies, according to research published in JAMA.

Mandatory screening resulted in a 33.4% decline in the death rate due to CCHD, a condition which was responsible for 2734 deaths between 2007 and 2013, per data from the National Center for Health Statistics.

“Screening for CCHD using pulse oximetry is a simple test using existing technology,” study author Matthew E. Oster, MD, MPH, the director of Children’s Cardiac Outcomes Research Program at Sibley Heart Center and an associate professor of pediatrics at Emory University School of Medicine in Atlanta, Georgia, told MD Magazine. “It is performed at the bedside, is non-invasive, and takes only a few minutes to complete. While uptake was slow in the beginning, fortunately, it is now mandatory in almost all states.”

The study examined birth and infant death data in the United States from January 1, 2007, through June 30, 2013. Data included 26,546,503 births and 6701 infant deaths (CCHD, 40.8%; Other/unspecified cardiac causes, 59.2%). The investigators defined states as having policies that were either mandatory (n = 8) or nonmandatory (n =14), the latter including voluntary policies (n =5) and not-yet-implemented policies (n =9).

The CCHD rates in the mandatory states was 8.0 per 100,000 births (95% CI, 5.4-10.6; n = 37) in 2007, decreasing to 6.4 per 100,000 births (95% CI, 2.9-9.9; n = 13) in 2013. The rates of death for other/unspecified causes per 100,000 births were 11.7 (95% CI, 8.6-14.8; n = 54) in 2007 and 10.3 (95% CI, 5.9-14.8; n = 21).

“Our study shows that mandatory implementation by states had a greater association with reduced infant cardiac deaths than did voluntary screening by hospitals,” Oster said. “In the United States, almost all states now mandate newborn screening for critical congenital heart disease using pulse oximetry. These findings have important implications for other countries considering mandating such a policy.”

When comparing data from states that implemented mandatory screening to previous periods without mandatory screening and states without screening through December 31, 2013, the amount of early infant death (defined as between 24 hours and 6 months of age) had an absolute decline to 3.9 deaths per 100,000 births (33.4%; 95% CI, 3.6-4.1).

In that same time frame, infant death due to other/unspecified causes decreased by 21.4% (95% CI, 6.9-33.7) with an absolute decline of 3.5 deaths per 100,000 births (95% CI, 3.2-3.8).

No significant decrease was linked with nonmandatory screening policies.

These results are “underscored” by historical context, according to an accompanying editorial by Alex R. Kemper, MD, MPH, MS; Wendy K. Lam, PhD; and Joseph A. Bocchini Jr., MD. The trio wrote that “most newborn screening is performed to detect selected metabolic, endocrine, or hematologic disorders using dried blood spots,” noting that the addition of more screening programs, such as those for newborn hearing loss, “enables public health programs to help families receive care.”

“The resources needed to expand newborn screening must be weighed against the expected benefit, and because virtually all newborns are screened, the potential harms (eg, false positives, overdiagnosis) must be carefully considered,” Kemper, Lam, and Bocchini wrote.

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