Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-11T13:03:41.324Z Has data issue: false hasContentIssue false
  • English
  • Français

Infants born with critical CHD in Arizona and capacities of birth centres for screening and management*

Published online by Cambridge University Press:  11 October 2017

Lydia Villa ,
Brent Bjornsen ,
Heather Giacone ,
Erica M. Weidler ,
Ekta Bajaj ,
Andrew Muth ,
Melanie Kennedy ,
Timothy Flood ,
Dianna Contreras  and
Joseph Spadafino
...Show all authors
Lydia Villa*
Affiliation:
Dignity Health St. Joseph’s Hospital, Phoenix, Arizona, United States of America
Brent Bjornsen
Affiliation:
Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
Heather Giacone
Affiliation:
Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
Erica M. Weidler
Affiliation:
Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
Ekta Bajaj
Affiliation:
Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
Andrew Muth
Affiliation:
Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
Melanie Kennedy
Affiliation:
Phoenix Children’s Hospital, Phoenix, Arizona, United States of America
Timothy Flood
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona, United States of America
Dianna Contreras
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona, United States of America
Joseph Spadafino
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona, United States of America
Ashish Shah
Affiliation:
John’s Hopkins All Children’s Heart Institute, St. Petersburg, Florida, United States of America
*
Correspondence to: Lydia Villa, MD, Dignity Health St. Joseph’s Hospital, 500 W Thomas Rd., Suite 250, Phoenix, AZ 85013, United States of America. Tel: 602 406 3520; Fax: 602 406 6162; E-mail: Lydia.Villa@DignityHealth.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The aims of this study were to identify locations of births in Arizona with critical CHD, as well as to assess the current use of pulse-oximetry screening and capacities of birth centres to manage a positive screen.

Study design

Infants (n=487) with a potentially critical CHD were identified from the Arizona Department of Health Services from 2012 and 2013; charts were retrospectively reviewed. Diagnosis was confirmed using echocardiographies. ArcGIS was used to generate maps to visualise the location of treating facility and mother’s residence. Birth centres were surveyed to assess screening practices and capacities to manage critical CHD in 2015.

Results

Of the 272 patients identified with critical CHD, 52% had been diagnosed prenatally. Patients travelled an average distance of 55.1 miles to their treating facility. Mortality was not related to prenatal diagnosis (p=0.30), living at a high elevation (p=0.82), or to distance travelled to the treating facility (p=0.68). Of 50 birth centres, 33 responded to the survey and all centres practiced critical CHD screening. A total of 25 centres could perform paediatric echocardiographies; 64% of these centres could digitally transmit echocardiograms. In all, 24 birth centres maintained access to prostaglandins.

Conclusions

Pulse-oximetry screening in newborns is currently implemented in the majority of Arizona hospitals. Although most centres could perform initial management steps following a positive screen, access to paediatric cardiology services was limited. Patients with critical CHD sometimes travelled a great distance to treating facilities. Digital transmission of echocardiograms or tele-echocardiography would reduce the distance travelled for the management of a positive screen, decrease the financial burden of transportation, and expedite care for critically ill neonates.

Keywords

Critical CHDpulse oximetrynewbornscreeningArizona
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 276 - 283
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The abstract of this paper was presented as poster at AAP 2016 Conference.

References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
2. Botto, LD, Correa, A, Erickson, JD. Racial and temporal variations in the prevalence of heart defects. Pediatrics 2001; 107: E32.CrossRefGoogle ScholarPubMed
3. Oster, ME, Lee, KA, Honein, MA, Riehle-Colarusso, T, Shin, M, Correa, A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics 2013; 131: e1502–e1508.CrossRefGoogle ScholarPubMed
4. Kemper, AR, Mahle, WT, Martin, GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128: e1259–e1267.CrossRefGoogle ScholarPubMed
5. The American Academy of Pediatrics. Newborn screening for congenital heart disease (page from AAP State Advocacy), 2016. Retrieved March 29, 2015, from https://www.aap.org/en-us/advocacy-and-policy/state-advocacy.Google Scholar
6. Beissel, DJ, Goetz, EM, Hokanson, JS. Pulse oximetry screening in Wisconsin. Congenit Heart Dis 2012; 7: 460–465.CrossRefGoogle ScholarPubMed
7. CDC. CfDCP: assessment of current practices and feasibility of routine screening for critical congenital heart defects – Georgia, 2012. Morb Mortal Wkly Rep, 2013; 62: 288–291.Google Scholar
8. Kochilas, LK, Lohr, JL, Bruhn, E, et al. Implementation of critical congenital heart disease screening in Minnesota. Pediatrics 2013; 132: e587–e594.CrossRefGoogle ScholarPubMed
9. McDermott, TL, Vernon, MM, Schultz, AH. Voluntary implementation of critical congenital heart disease screening in Washington hospitals. Hosp Pediatr 2015; 5: 193–202.CrossRefGoogle ScholarPubMed
10. Johnson, LC, Lieberman, E, O’Leary, E, Geggel, RL. Prenatal and newborn screening for critical congenital heart disease: findings from a nursery. Pediatrics 2014; 134: 916–922.CrossRefGoogle ScholarPubMed
11. Pinto, NM, Lasa, J, Dominguez, TE, Wernovsky, G, Tabbutt, S, Cohen, MS. Regionalization in neonatal congenital heart surgery: the impact of distance on outcome after discharge. Pediatr Cardiol 2012; 33: 229–238.CrossRefGoogle ScholarPubMed
12. U.S. Census Bureau. Population estimates: current estimates data, 2016. Retrieved March 15, 2015, from http://www.census.gov/popest/data/index.html.Google Scholar
13. Dawson, AL, Cassell, CH, Riehle-Colarusso, T, et al. Factors associated with late detection of critical congenital heart disease in newborns. Pediatrics 2013; 132: e604–e611.CrossRefGoogle ScholarPubMed
14. Good, RJ, Canale, SK, Goodman, RL, Yeager, SB. Identification of critical congenital heart disease in Vermont: the role of universal pulse oximetry screening in a rural state. Clin Pediatr (Phila) 2015; 54: 570–574.CrossRefGoogle Scholar
15. International Society of Ultrasound in Obstetrics and Gynecology, Carvalho, JS, Allan, LD, et al. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41: 348–359.CrossRefGoogle Scholar
16. Lannering, K, Bartos, M, Mellander, M. Late diagnosis of coarctation despite prenatal ultrasound and postnatal pulse oximetry. Pediatrics 2015; 136: e406–e412.CrossRefGoogle ScholarPubMed
17. Ewer, AK, Middleton, LJ, Furmston, AT, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet 2011; 378: 785–794.CrossRefGoogle ScholarPubMed
18. de-Wahl Granelli, A, Wennergren, M, Sandberg, K, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ 2009; 338: a3037.CrossRefGoogle Scholar
19. Friedberg, MK, Silverman, NH, Moon-Grady, AJ, et al. Prenatal detection of congenital heart disease. J Pediatr 2009; 155: 26–31; 31.e21.CrossRefGoogle ScholarPubMed
20. Quartermain, MD, Pasquali, SK, Hill, KD, et al. Variation in prenatal diagnosis of congenital heart disease in infants. Pediatrics 2015; 136: e378–e385.CrossRefGoogle ScholarPubMed
21. Liberman, RF, Getz, KD, Lin, AE, et al. Delayed diagnosis of critical congenital heart defects: trends and associated factors. Pediatrics 2014; 134: e373–e381.CrossRefGoogle ScholarPubMed
22. Chang, RK, Klitzner, TS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 2002; 109: 173–181.CrossRefGoogle ScholarPubMed
23. Hannan, EL, Racz, M, Kavey, RE, Quaegebeur, JM, Williams, R. Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 1998; 101: 963–969.CrossRefGoogle ScholarPubMed
24. Jenkins, KJ, Newburger, JW, Lock, JE, Davis, RB, Coffman, GA, Iezzoni, LI. In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 1995; 95: 323–330.CrossRefGoogle ScholarPubMed
25. Webb, CL, Waugh, CL, Grigsby, J, et al. Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study. J Am Soc Echocardiogr 2013; 26: 1090–1098.CrossRefGoogle ScholarPubMed
26. Sable, C, Roca, T, Gold, J, Gutierrez, A, Gulotta, E, Culpepper, W. Live transmission of neonatal echocardiograms from underserved areas: accuracy, patient care, and cost. Telemed J 1999; 5: 339–347.CrossRefGoogle ScholarPubMed
27. Center for Connected Health Policy – The National Telehealth Policy Resource Center. State telehealth laws and Medicaid program policies, 2014. Retrieved March 25, 2016, from http://cchpca.org/sites/default/files/uploader/50%20STATE%20MEDICAID%20REPORT%20SEPT%202014.pdf.Google Scholar
28. Haley, JE, Klewer, SE, Barber, BJ, et al. Remote diagnosis of congenital heart disease in southern Arizona: comparison between tele-echocardiography and videotapes. Telemed J E Health 2012; 18: 736–742.CrossRefGoogle ScholarPubMed
29. Hellström-Westas, L, Hanséus, K, Jögi, P, Lundström, NR, Svenningsen, N. Long-distance transports of newborn infants with congenital heart disease. Pediatr Cardiol 2001; 22: 380–384.CrossRefGoogle ScholarPubMed
30. Morris, SA, Ethen, MK, Penny, DJ, et al. Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation 2014; 129: 285–292.CrossRefGoogle ScholarPubMed
31. Moffett, BS, Garrison, JM, Hang, A, et al. Prostaglandin availability and association with outcomes for infants with congenital heart disease. Pediatr Cardiol 2016; 37: 338–344.CrossRefGoogle ScholarPubMed
32. Holland, BJ, Myers, JA, Woods, CR. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol 2015; 45: 631–638.CrossRefGoogle ScholarPubMed
33. Lang, A, Brun, H, Kaaresen, PI, Klingenberg, C. A population based 10-year study of neonatal air transport in North Norway. Acta Paediatr 2007; 96: 995–999.CrossRefGoogle ScholarPubMed
34. Tworetzky, W, McElhinney, DB, Reddy, VM, et al. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001; 103: 1269–1273.CrossRefGoogle ScholarPubMed
35. Bonnet, D, Coltri, A, Butera, G, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99: 916–918.CrossRefGoogle ScholarPubMed
36. Ravert, P, Detwiler, TL, Dickinson, JK. Mean oxygen saturation in well neonates at altitudes between 4498 and 8150 feet. Adv Neonatal Care 2011; 11: 412–417.CrossRefGoogle ScholarPubMed
37. Wright, J, Kohn, M, Niermeyer, S, Rausch, CM. Feasibility of critical congenital heart disease newborn screening at moderate altitude. Pediatrics 2014; 133: e561–e569.CrossRefGoogle ScholarPubMed
38. Flagstaff Medical Center. About FMC, 2015. Retrieved March 15, 2015, from http://www.flagstaffmedicalcenter.com/AboutFMC.Google Scholar
39. Yuma Regional Medical Center. Pregnancy and childbirth, 2016. Retrieved April 25, 2015, from http://www.yumaregional.org/pregnancy-and-childbirth.Google Scholar
40. Justo, R, Smith, AC, Williams, M, et al. Paediatric telecardiology services in Queensland: a review of three years’ experience. J Telemed Telecare 2004; 10 (Suppl 1): 57–60.CrossRefGoogle ScholarPubMed
41. Sable, CA, Cummings, SD, Pearson, GD, et al. Impact of telemedicine on the practice of pediatric cardiology in community hospitals. Pediatrics 2002; 109: E3.CrossRefGoogle ScholarPubMed
42. Arizona Department of Health Services, Bureau of Emergency Medical Service & Trauma System. Arizona Ground Ambulance Service rate schedule, 2015. Retrieved July 15, 2016, from http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/ambulance/ground/rates/ground-ambulance-rate-oct-2015.pdf.Google Scholar
43. Arizona Department of Health Services, Bureau of Emergency Medical Service & Trauma System. Arizona Air Ambulance Service rate schedule, 2016. Retrieved August 30, 2016, from http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/ambulance/air/AirRateSchedule.pdf.Google Scholar
44. Singh, A, Rasiah, SV, Ewer, AK. The impact of routine predischarge pulse oximetry screening in a regional neonatal unit. Arch Dis Child Fetal Neonatal Ed 2014; 99: F297–F302.CrossRefGoogle Scholar