Factors associated with late detection of critical congenital heart disease in newborns
Published Date:Aug 12 2013
Congenital Heart Disease
Heart Defects, Congenital
Pubmed Central ID:PMC4617641
Funding:CC999999/Intramural CDC HHS/United States
Critical congenital heart disease (CCHD) was added recently to the U.S. Recommended Uniform Screening Panel for newborns. This study assessed whether maternal/household and infant characteristics were associated with late CCHD detection.
This was a state-wide, population-based, retrospective, observational study of infants with CCHD born 1998-2007 identified by the Florida Birth Defects Registry. We examined 12 CCHD conditions that are primary and secondary targets of newborn CCHD screening by pulse oximetry. We used Poisson regression models to analyze associations between selected characteristics (e.g., maternal age, CCHD type, and birth hospital nursery level [highest level available in the hospital]) and late CCHD detection, which was defined as diagnosis after the birth hospitalization.
Of 3,603 infants with CCHD and linked hospitalizations, CCHD was not detected during the birth hospitalization for 22.9% (n=825) of infants. The likelihood of late detection varied by CCHD condition. Infants born in a birth hospital with a Level I nursery only (adjusted prevalence ratio [aPR] 1.9, 95% confidence interval (CI) 1.6-2.2) or Level II nursery (aPR 1.5, 95% CI 1.3-1.7) were significantly more likely to have late-detected CCHD compared to infants born in a birth hospital with a Level III (highest) nursery.
After controlling for the selected characteristics, hospital nursery level appears to have an independent association with late CCHD detection. Thus, perhaps universal newborn screening for CCHD could be particularly beneficial in Levels I and II nurseries and may reduce differences in the frequency of late diagnosis between birth hospital facilities.
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