Published online October 2, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1250-e1256 (doi:10.1542/10.1542/peds.2005-3061)

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SPECIAL ARTICLE

Report of the Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease

Michael R. Liske, MD^a, Christopher S. Greeley, MD^b, David J. Law, PhD^c, Jonathan D. Reich, MD, MSc^d, William R. Morrow, MD^e, H. Scott Baldwin, MD^a, Thomas P. Graham, MD^a, Arnold W. Strauss, MD^a, Ann L. Kavanaugh-McHugh, MD^a and William F. Walsh, MD^f

^a Divisions of Pediatric Cardiology
^b General Pediatrics
^f Neonatology, Monroe Carell Jr Children's Hospital, Vanderbilt Medical Center, Nashville, Tennessee
^c Tennessee Department of Health, Nashville, Tennessee
^d Watson Clinic Center for Research, Lakeland, Florida
^e Division of Pediatric Cardiology, University of Arkansas, Little Rock, Arkansas

A member of the Tennessee state legislature recently proposed a bill that would mandate all newborn infants to undergo pulse oximetry screening for the purpose of identifying those with critical structural heart disease before discharge home. The Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Defects was convened on September 29, 2005. This group reviewed the current medical literature on this topic, as well as data obtained from the Tennessee Department of Health, and debated the merits and potential detriments of a statewide screening program. The estimated incidence of critical congenital heart disease is 170 in 100000 live births, and of those, 60 in 100000 infants have ductal-dependent left-sided obstructive lesions with the potential of presentation by shock or death if the diagnosis is missed. Of the latter group, the diagnosis is missed in 9 in 100 000 by fetal ultrasound assessment and discharge examination and might be identified by a screening program. Identification of the missed diagnosis in these infants before discharge could spare many of them death or neurologic sequelae. Four major studies using pulse oximetry screening were analyzed, and when data were restricted to critical left-sided obstructive lesions, sensitivity values of 0% to 50% and false-positive rates of between 0.01% and 12% were found in asymptomatic populations. Because of this variability and other considerations, a meaningful cost/benefit analysis could not be performed. It was the consensus of the task force to provide a recommendation to the legislature that mandatory screening not be implemented at this time. In addition, we determined that a very large, prospective, perhaps multistate study is needed to define the sensitivity and false-positive rates of lower-limb pulse oximetry screening in the asymptomatic newborn population and that there needs to be continued partnering between the medical community, parents, and local, state, and national governments in decisions regarding mandated medical care.

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Key Words: critical congenital heart disease • screening • pulse oximetry • hypoplastic left heart syndrome

Abbreviations: AAP—American Academy of Pediatrics • NBS—newborn screening • HLHS—hypoplastic left heart syndrome • AS—aortic stenosis • COA—coarctation of the aorta • IAA—interrupted aortic arch

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Accepted Apr 19, 2006.

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