Factors associated with late detection of critical congenital heart disease in newborns.
OBJECTIVE
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.
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA. isp3@cdc.gov
April L
AL
Dawson
Cynthia H
CH
Cassell
Tiffany
T
Riehle-Colarusso
Scott D
SD
Grosse
Jean Paul
JP
Tanner
Russell S
RS
Kirby
Sharon M
SM
Watkins
Jane A
JA
Correia
Richard S
RS
Olney
D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003696:Delivery Rooms / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D010351:Patient Discharge / Q000706:statistics & numerical data; D016012:Poisson Distribution; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
congenital heart disease; neonatal screening