Association of US State Implementation of Newborn Screening Policies for Critical Congenital Heart Disease With Early Infant Cardiac Deaths

Abstract

IMPORTANCE In 2011, critical congenital heart disease was added to the US Recommended Uniform Screening Panel for newborns, but whether state implementation of screening policies has been associated with infant death rates is unknown. OBJECTIVE To assess whether there was an association between implementation of state newborn screening policies for critical congenital heart disease and infant death rates. DESIGN, SETTING, AND PARTICIPANTS Observational study with group-level analyses. A difference-in-differences analysis was conducted using the National Center for Health Statistics’ period linked birth/infant death data set files for 2007–2013 for 26 546 503 US births through June 30, 2013, aggregated by month and state of birth. EXPOSURES State policies were classified as mandatory or nonmandatory (including voluntary policies and mandates that were not yet implemented). As of June 1, 2013, 8 states had implemented mandatory screening policies, 5 states had voluntary screening policies, and 9 states had adopted but not yet implemented mandates. MAIN OUTCOMES AND MEASURES Numbers of early infant deaths (between 24 hours and 6 months of age) coded for critical congenital heart disease or other/unspecified congenital cardiac causes for each state-month birth cohort. RESULTS Between 2007 and 2013, there were 2734 deaths due to critical congenital heart disease and 3967 deaths due to other/unspecified causes. Critical congenital heart disease death rates in states with mandatory screening policies were 8.0 (95% CI, 5.4–10.6) per 100 000 births (n = 37) in 2007 and 6.4 (95% CI, 2.9–9.9) per 100 000 births (n = 13) in 2013 (for births by the end of July); for other/unspecified cardiac causes, death rates were 11.7 (95% CI, 8.6–14.8) per 100 000 births in 2007 (n = 54) and 10.3 (95% CI, 5.9–14.8) per 100 000 births (n = 21) in 2013. Early infant deaths from critical congenital heart disease through December 31, 2013, decreased by 33.4% (95% CI, 10.6%–50.3%), with an absolute decline of 3.9 (95% CI, 3.6–4.1) deaths per 100 000 births after states implemented mandatory screening compared with prior periods and states without screening policies. Early infant deaths from other/unspecified cardiac causes declined by 21.4% (95% CI, 6.9%–33.7%), with an absolute decline of 3.5 (95% CI, 3.2–3.8) deaths per 100 000 births. No significant decrease was associated with nonmandatory screening policies. CONCLUSIONS AND RELEVANCE Statewide implementation of mandatory policies for newborn screening for critical congenital heart disease was associated with a significant decrease in infant cardiac deaths between 2007 and 2013 compared with states without these policies.

Is echocardiography necessary for all single umbilical artery fetuses? A retrospective study in a selected Chinese population

“…In our study, the incidence of CHD in the selected population of SUA fetuses (12.5%) was much higher than the unselected population (8–1%) . All major CHD were detectable by 4CV or OTV during the routine second‐trimester obstetric screening ultrasound examination.…”

Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge

“…An analysis of the importance of timely diagnosis of CCHD, performed in the USA and based on a birth defect registry, stated that potentially preventable death occurred in 1.8% of infants with late detected CCHD, and that a late diagnosis was associated with more and longer hospital admissions, and higher inpatient costs [22]. Abouk et al reported a reduction in early infant deaths from critical congenital heart disease from 33.4%, with an absolute decline of 3.9%, after states implemented mandatory screening compared with prior periods and states without screening policies [1]. Taking into account this reduction in mortality, Grosse et al estimate the cost per life-year gained at $12,000 [8].…”

“…However, this estimate does not include long-term costs of care and education of survivors, nor costs for support and monitoring of screening programs. If 3.9 deaths per 100,000 births can be prevented, and assuming a life expectancy of 60 years with a utility of 0.75 (conservative assumption, lower than general population), a total of 164 QALYs can be gained per 100,000 births (83 QALYs with 3% discounting) [1, 10]. Combining this with the incremental costs for PO screening of €1,671,000, this results in a cost-effectiveness-ratio of €10,183 per QALY (or €20,000 with 3% discounting).…”

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“…Cardiac development is a very intricate process regulated by precise temporal and spatial expression patterns of heart development‐related genes. Several studies have shown that both genetic and epigenetic factors play a critical role in the expression of cardiomyogenesis genes . As a common environmental teratogen, alcohol consumption during pregnancy has been reported to cause CHD in foetuses .…”