title: Implementation of critical congenital heart disease screening in Minnesota.
abstract: OBJECTIVE
  To assess the level of preparedness and resources needed in Minnesota for the implementation of newborn screening for critical congenital heart diseases (CCHDs).
  
  
  METHODS
  A cross sectional survey of all birth centers in Minnesota was performed to assess the capacity to deliver care essential for the CCHD screening program. Compliance with the screening algorithm, nursing workload, and cost were assessed by using a pilot program implemented in 6 normal newborn nurseries.
  
  
  RESULTS
  Ninety-one of 99 eligible centers participated in the survey and 90 reported the ability to screen newborns in accordance with recommendations. Only 22 centers, with 63% of births, had access to echocardiography and routinely stocked prostaglandins for neonatal use. Our pilot study screened 7549 newborns with 6 failed screens and 1 CCHD diagnosis. Two of the failed screens were due to misinterpretation of the algorithm, 1 failed screen was not reported, and 4 failed screens were not recognized. Repeated screens were required for 115 newborns, with 29% of retesting due to misinterpretation of the algorithm. The mean nursing time required was 5.5 minutes, and the cost was $5.10 per screen.
  
  
  CONCLUSIONS
  In Minnesota, two-thirds of newborns are born in centers with resources for initial diagnosis and management of CCHD. Implementation of a pilot screening program demonstrated minimal increase in nursing workload, but identified problems with interpretation of the algorithm and data reporting. This pilot project suggests the need for simplification of the algorithm, additional training of health care providers, and development of a centralized reporting mechanism.
authors: Divisions of aPediatric Cardiology, University of Minnesota, Minneapolis, MN, USA. kochilas@umn.edu
authors: Lazaros K
authors: LK
authors: Kochilas
authors: Jamie L
authors: JL
authors: Lohr
authors: Eric
authors: E
authors: Bruhn
authors: Emily
authors: E
authors: Borman-Shoap
authors: Becky L
authors: BL
authors: Gams
authors: Mary
authors: M
authors: Pylipow
authors: Annamarie
authors: A
authors: Saarinen
authors: Amy
authors: A
authors: Gaviglio
authors: Theodore R
authors: TR
authors: Thompson
mesh_terms: D000465:Algorithms; D016550:Birthing Centers / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000451:nursing / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006284:Health Plan Implementation / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology* / Q000451:nursing; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008910:Minnesota; D017283:Neonatal Nursing; D015997:Neonatal Screening / Q000451:nursing / Q000458:organization & administration*; D010092:Oximetry / Q000451:nursing / Q000706:statistics & numerical data*; D011453:Prostaglandins / Q000600:supply & distribution; D016526:Workload / Q000706:statistics & numerical data
chemical_list: D011453:Prostaglandins
keywords: congenital heart disease; newborn screening; pulse oximetry