Objective:To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening.Study Design:Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants).Results:Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ≥2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%).Conclusion:Given the majority of NICU infants were ≥2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.
Bibliographical noteFunding Information:
This project was partially supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under Grant Number H46MC24059, Genetic Services Project (CCHD Screening). The content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US Government. We acknowledge the efforts from all participating centers to implement the evaluation as well as collect and enter data. Thanks to the key contributors and staffs from the following NICUs: Naheed Abedin, Capital Health Medical Center-Hopewell; Patricia Benedetto, Mary Keller-Olsen, Children’s Hospital of NJ at Newark Beth Israel Medical Center; Mayuri Shah, Krystyna Toczylowski, Hackensack Medical Center; Michael Carter, Jersey Shore Medical Center; Stephanie Salerno, Laura Padvarietis, Long Island Jewish (LIJ) Cohen Children’s Medical Center; Patricia Quinn, LIJ Lenox Hill; Jennifer Ruggiano, LIJ North Shore; John Ladino, Megan Shea, Morristown Medical Center; Bonnie Adler, Lisa D’Amico, Monmouth Medical Center; Laura Wenzel, Northwell Staten Island University Hospital, St Joseph’s Healthcare System; Pansy Haynes-Mayfield, Debbie Bowman, Sunita Shah, Edith Legaspi, Saint Peter’s University Hospital; Angela Huang, Wei-Fen Den, Santa Clara Valley Medical Center; Nithi Fernandes, Mike Sacilowski, University of Buffalo Medical Center; Kelsey Balcer, University of Illinois Medical Center; Debra Brendel, University of Medicine and Dentistry of NJ; Bev Rose, Melissa Engel, University of Minnesota Masonic Children’s Hospital (UMMCH); Juanita Royle, Fairview Ridges Hospital; Juanita Royle, Nanette Nys, Fairview Southdale Hospital; Katie Pfister, Maple Grove Hospital; Mary Pat Osborne, North Memorial Medical Center; Thomas George, NICU UMMCH, Fairview Ridges/Southdale Hospitals. We thank the NJ NICU Collaborative for their support of this project. We thank Emily Carey PerezdeAlejo, Office of Continuing Professional Education, Rutgers, The State University of New Jersey, for assistance with development of the data instrument and technical support throughout the project. We also show our gratitude to Fran Gallagher, Harriett Lazarus, and Lindsay Caporrino, NJ Chapter, American Academy of Pediatrics, and Mary Knapp, Marilyn Gorney-Daley, and Joy Rende, Early Identification and Monitoring Program, Special Child Health and Early Intervention Services, Division of Family Health Services, NJ Department of Health, for support of this evaluation.