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Requiring Newborn Screening Of Critical Congenital Heart Disease

1777 words - 8 pages

Requiring Newborn Screening of Critical Congenital Heart Disease

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With the numerous technological advances that have occurred in today’s health care system, one would think newborn screening would be required in Maryland for the most common birth defect in the United States, critical congenital heart disease (CCHD), but only just this year has the state considered the requirement (Department of Legislative Services, Office of Information Systems [DLSOIS], 2011). Critical congenital heart disease, a disorder in which an infant’s heart or blood vessels near the heart develop abnormally before birth, affects approximately 8 out of every 1,000 infants each year in the US, amounting to ...view middle of the document...

d.). Research by Chang, Gurvitz and Rodriguez (2008) for the American Medical Association analyzed death registry data to identify infants with CCHD who died when the diagnosis was either unknown or made too late for surgical intervention (Chang, Gurvitz, & Rodriguez, 2008). At the end of the study, the researchers concluded up to 30 infants per year died of a missed or late diagnosis of CCHD in the state of California alone (Chang, Gurvitz, & Rodriguez, 2008). And according to data presented by Martin, Bradshaw, & Wright (n.d.), as of 2006, approximately 43% of infants in the US were given late diagnoses of CCHD (Martin, Bradshaw, & Wright, n.d.). If newborn screening for CCHD had been included and/or emphasized earlier diagnostic intervention, there could have been a decrease in the number of infant deaths each year.
Another benefit of implementing CCHD screening is with the proposed method of diagnosis, called pulse oximetry testing. Pulse oximetry testing is a quick, non-invasive and relatively simple test which estimates the percentage of hemoglobin in the blood and detects abnormalities attributed to CCHD (Knapp, Metterville, Kemper, Prosser, & Perrin, 2010). This form of screening mostly occurs at the bedside in a nursery, and is relatively similar to other newborn screenings already being performed in hospitals (Knapp et al., 2010). A study done by Knapp et al. (2010) for the American Academy of Pediatrics that monitored the accuracy of pulse oximetry testing on a number of asymptomatic newborns concluded that pulse oximetry testing is extremely effective in detecting CCHD in newborns, and should be applied throughout the country (Koppel et al., 2003). Also, routine pulse oximetry screening performed 24 hours after birth incurs low risk of harm to the infant (DLSOIS, 2011).
Many centers, hospitals, committees, and states across the country have shown extensive support of the inclusion of CCHD screening. The Children’s National Medical Center, for example, has worked with Holy Cross Hospital to become leaders in the implementation of pulse oximetry screening in their local nurseries (DLSOIS, 2011). Their aims are to determine if pulse oximetry testing could be implemented in community hospitals, to identify potential obstacles associated with implementing pulse oximetry testing and work to address them, and to further evaluate the effectiveness of pulse oximetry testing after implementation (Martin, Bradshaw, & Wright, n.d.). Furthermore, the Secretary of Health and Human Services’ Advisory Committee for Heritable Disorders in Newborns and Children has supported and even recommended the addition of CCHD screening for all infants in the United States (DLSOIS, 2011). Since many large organizations already support implementing CCHD screening, this only indicates the ease Maryland and other states would have in including this in their newborn screening programs. Moreover, thirteen states have requested that CCHD...

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