Current Postlaunch Implementation of State Mandates of Newborn Screening for Critical Congenital Heart Disease by Pulse Oximetry in U.S. States and Hospitals

Rie Sakai-Bizmark; Ruey-Kang R Chang; Gerard R Martin; Lisa A Hom; Emily H Marr; Jamie Ko; Donna A Goff; Laurie A Mena; Connie von Kohler; Lauren E M Bedel; Mary Murillo; Dennys Estevez; Ron D Hays

doi:10.1055/s-0042-1756327

Current Postlaunch Implementation of State Mandates of Newborn Screening for Critical Congenital Heart Disease by Pulse Oximetry in U.S. States and Hospitals

Am J Perinatol. 2022 Dec 29. doi: 10.1055/s-0042-1756327. Online ahead of print.

Authors

Rie Sakai-Bizmark^{1

2}, Ruey-Kang R Chang^{2

3}, Gerard R Martin³, Lisa A Hom⁴, Emily H Marr¹, Jamie Ko^{2

5}, Donna A Goff⁶, Laurie A Mena¹, Connie von Kohler⁷, Lauren E M Bedel¹, Mary Murillo¹, Dennys Estevez¹, Ron D Hays^{8

9}

Affiliations

¹ Division of General Pediatrics, Lundquist Institute for Biomedical Innovation, Torrance, California.
² Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Torrance, California.
³ Division of Cardiology, Lundquist Institute for Biomedical Innovation, Torrance, California.
⁴ Division of Cardiology, Children's National Hospital, the George Washington University School of Medicine, Washington, District of Columbia.
⁵ Division of Pediatric Hospital Medicine, Lundquist Institute for Biomedical Innovation, Torrance, California.
⁶ Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
⁷ Miller Children's and Women's Hospital Long Beach, MemorialCare Health System, Long Beach, California.
⁸ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
⁹ Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California.

PMID: 36580978
DOI: 10.1055/s-0042-1756327

Abstract

Objective: Our objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics.

Study design: Between March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements.

Results: Responses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO₂ as an immediate failed screen and 31% responded that an infant with SpO₂ of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = -1.23 p = 0.01) and early adoption by states (beta = -1.01, p < 0.01).

Conclusion: When presented with SpO₂ screening values on a questionnaire, a low percentage of nurse supervisors selected responses that demonstrated adherence to nationally endorsed protocols for CCHD screening. Most notably, almost one-third of respondents did not recognize ≤90% SpO₂ as a failed screen that requires immediate physician follow-up. In addition, states without reporting mandates and early adopter states were associated with low policy consistency. Implementing state reporting requirements might increase policy consistency, but some inconsistency may be the result of unique protocols in early adopter states that differ from nationally endorsed protocols.

Key points: · Low adherence to nationally endorsed protocols.. · Inconsistent physician follow-up to hypoxia.. · Reporting improved consistency with national policy..

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).