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American Academy of Pediatrics
Article

Factors Associated With Late Detection of Critical Congenital Heart Disease in Newborns

April L. Dawson, Cynthia H. Cassell, Tiffany Riehle-Colarusso, Scott D. Grosse, Jean Paul Tanner, Russell S. Kirby, Sharon M. Watkins, Jane A. Correia and Richard S. Olney
Pediatrics September 2013, 132 (3) e604-e611; DOI: https://doi.org/10.1542/peds.2013-1002
April L. Dawson
aNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
bOak Ridge Institute of Science and Education, Oak Ridge, Tennessee;
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Cynthia H. Cassell
aNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Tiffany Riehle-Colarusso
aNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Scott D. Grosse
aNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Jean Paul Tanner
cBirth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida; and
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Russell S. Kirby
cBirth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida; and
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Sharon M. Watkins
dFlorida Birth Defects Registry, Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida
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Jane A. Correia
dFlorida Birth Defects Registry, Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida
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Richard S. Olney
aNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Abstract

OBJECTIVES: Critical congenital heart disease (CCHD) was recently added to the US Recommended Uniform Screening Panel for newborns. This study assessed whether maternal/household and infant characteristics were associated with late CCHD detection.

METHODS: This was a statewide, population-based, retrospective, observational study of infants with CCHD born between 1998 and 2007 identified by using the Florida Birth Defects Registry. We examined 12 CCHD conditions that are primary and secondary targets of newborn CCHD screening using pulse oximetry. We used Poisson regression models to analyze associations between selected characteristics (eg, CCHD type, birth hospital nursery level [highest level available in the hospital]) and late CCHD detection (defined as diagnosis after the birth hospitalization).

RESULTS: Of 3603 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: 1.9 [95% confidence interval: 1.6–2.2]) or level II nursery (adjusted prevalence ratio: 1.5 [95% confidence interval: 1.3–1.7]) were significantly more likely to have late-detected CCHD compared with infants born in a birth hospital with a level III (highest) nursery.

CONCLUSIONS: After controlling for the selected characteristics, hospital nursery level seems to have an independent association with late CCHD detection. Thus, perhaps universal newborn screening for CCHD could be particularly beneficial in level I and II nurseries and may reduce differences in the frequency of late diagnosis between birth hospital facilities.

  • congenital heart disease
  • neonatal screening
  • Abbreviations:
    AHCA —
    Agency for Health Care Administration
    aPR —
    adjusted prevalence ratio
    CCHD —
    critical congenital heart disease
    CHD —
    congenital heart disease
    CI —
    confidence interval
    FBDR —
    Florida Birth Defects Registry
    ICD-9-CM —
    International Classification of Disease, Ninth Revision, Clinical Modification
    • Accepted June 19, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
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    1 Sep 2013
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    Factors Associated With Late Detection of Critical Congenital Heart Disease in Newborns
    April L. Dawson, Cynthia H. Cassell, Tiffany Riehle-Colarusso, Scott D. Grosse, Jean Paul Tanner, Russell S. Kirby, Sharon M. Watkins, Jane A. Correia, Richard S. Olney
    Pediatrics Sep 2013, 132 (3) e604-e611; DOI: 10.1542/peds.2013-1002

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    Factors Associated With Late Detection of Critical Congenital Heart Disease in Newborns
    April L. Dawson, Cynthia H. Cassell, Tiffany Riehle-Colarusso, Scott D. Grosse, Jean Paul Tanner, Russell S. Kirby, Sharon M. Watkins, Jane A. Correia, Richard S. Olney
    Pediatrics Sep 2013, 132 (3) e604-e611; DOI: 10.1542/peds.2013-1002
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