Seven years after the American Academy of Pediatrics recommended it, a new study reveals that mandatory state newborn screening for critical congenital heart disease (CCHD) has been a successful public health intervention. The study, published in JAMA earlier this month, compared statistics from states that adopted pulse oximetry screening performed in newborn nurseries and those that didn’t:
In this observational study conducted between 2007 and 2013 including approximately 27 million US births, state adoption of a mandatory screening policy was associated with a statistically significant decline of 33.4% in the death rate due to critical congenital heart disease compared with states without such policies.
States that did not have mandatory screening policies saw no decrease in infant deaths from CCHD.
Congenital heart defects are the most common forms of birth defects in the United States, affecting roughly 40,000 babies (about 1% of all live births) each year. Most of these heart defects are not life-threatening, and many do not require any treatment. The most common congenital heart disease is a ventricular septal defect — a hole in the muscular wall separating the heart’s two lower chambers — which almost always closes up on its own within a year. However, about 25% of infants born with congenital heart disease have a critical defect, where life-saving medicine, surgery, or other procedures are necessary in the first year of life. A few CCHDs include coarctation of the aorta, hypoplastic left heart syndrome, transposition of the great arteries, truncus arteriosus, and tetralogy of Fallot. Serious disturbances of normal cardiac anatomy such as these are usually not revealed by prenatal ultrasounds and other prenatal tests. And even though these abnormalities are dire, symptoms of cardiac compromise might not be evident for hours to several days to several weeks after birth, when the heart’s function finally deteriorates and the first signs of respiratory distress and cyanosis (blue discoloring of the skin) appear, both indicating low oxygen in the bloodstream. Mandatory blood oxygen testing before newborns are discharged home from the nursery is clearly helpful in catching those asymptomatic babies with CCHD, leading to medical and surgical interventions before the rapidly-progressing symptoms of cardiac decompensation appear. As more states adopt mandatory newborn screening for CCHD — testing which is relatively simple, inexpensive, and non-invasive — more babies’ lives will be saved.