Routine newborn screening for congenital heart defects in New Jersey hospitals was an easy-to-implement procedure that didn’t substantially impact the cost of either labor or materials.

Yet in Georgia, hospitals that hadn’t implemented this nationally recommended protocol cited concerns about staffing and equipment as barriers to carrying out such screening, according to two reports published in the April 19 issue of the Morbidity and Mortality Weekly Report (2013;62:288-91, 292-4).

In 2011, the U.S. Secretary of Health and Human Services recommended that the Recommended Uniform Screening Panel (RUSP) for newborns include screening for critical congenital heart defects, which is generally accomplished by pulse oximetry. However, it’s up to each state to decide whether to make screening mandatory, and each hospital to decide how to implement it.

The new reports documented the results of surveys conducted by the Centers for Disease Control and Prevention, the Georgia Department of Public Health, and the New Jersey Department of Health. Surveys were sent to a sampling of birthing hospitals in each state. Georgia does not mandate screening; New Jersey does.

The Georgia survey asked the facilities to document whether or not screening was performed; how those screens were implemented, recorded, and followed up; and any barriers to screening.

Also, 11 pulse oximetry screenings were observed at five hospitals in Georgia. They found that screening took little time – an average of 10 minutes – and was easily conducted.

In that state, 71 facilities responded to the survey request. Of these, 22 (31%) were currently screening, 20 (28%) planned to start screening in 2012; 14 (20%) planned to start screening at some other time; and 15 (21%) had no plans to start.

The investigators, led by Pamela Clark of the Oak Ridge Institute for Science and Education, Tenn., found a number of barriers that hospitals said affected their decision to screen. Some (35%) said they did not have on-site echocardiography. Almost half (45%) said they had to transfer patients for screening, with a median driving distance of 54 miles.

Of the 29 hospitals that were not screening, 13 said they had no clear plan of how to follow up on positive results and 13 said they were unsure of how to report them.

Cost was an issue for everyone, the survey found. Seven of the 22 (32%) screening hospitals expressed concern about reimbursement, as did 8 of 20 (40%) of those who planned to start in 2012, 4 of 14 (29%) of those that were going to start at some other time, and 2 of 15 (13%) of those who had no plans to do it.

Equipment was a barrier for all of the nonscreening facilities: 35% of those who were going to start screening in 2012 said they needed to buy equipment, as did 50% of those who said they’d start some other time, and 33% of those who had no plans to start.

However, almost all of the hospitals said they already did record pulse oximetry or planned to start doing it, including 80% of the hospitals that weren’t going to screen, all of which recorded pulse oximetry in the electronic medical record.

All that did or would start screening have access to a pediatric cardiologist. Only one hospital that had no plans to screen and one that might start at some point said they had no access to such a specialist.

The lack of a state mandate also had an impact – almost half of the hospitals with no plans to start screening (47%) said that was a factor in their decision.

There were some concerns, however, even among the hospitals already screening: 12 didn’t know how often to send screening data to the Department of Public Health and 11 didn’t know what kind of data to send.

The picture in New Jersey, the first state to mandate screening, was quite different. Five months after the requirement went into effect on Aug. 31, 2011, a similar survey was carried out among a sample of 11 birthing hospitals. All of these were screening according to the recommendations using pulse oximetry.

Three hospitals submitted the data electronically, five manually, and three with both methods. Staff saw the handling and submission of records as a "moderate burden." Nurses said pulse oximetry was easily incorporated into their duties and was not burdensome.

During the first 3 months of screening, 98% of 25,214 newborns received the test. Twelve babies tested positive for a congenital heart defect, reported Dr. Lorraine F. Garg of the New Jersey Department of Health and her associates.

In addition to identifying heart problems, pulse oximetry screening could have other effects. "Pulse oximetry screening also might identify other medical conditions, such as pulmonary conditions or sepsis, potentially improving newborn care and subsequent outcomes," according to an editorial note.

msullivan@frontlinemedcom.com

States differ in screening for congenital heart defects