Report of the Tennessee Task Force on Screening Newborn Infants for Critical
Congenital Heart Disease
by: Michael R. Liske, MD, Christopher S. Greeley, MD, David J. Law, PhD,
Jonathan D. Reich, MD, MS, William R. Morrow, MD, H. Scott Baldwin, MD, Thomas
P. Graham, MD, Arnold W. Strauss, MD, Ann L. Kavanaugh-McHugh, MD and William F.
Walsh, MD
The Tennessee Task Force on Screening Newborn Infants for
Critical Congenital Heart Defects was convened on September 29, 2005. This group
reviewed the current medical literature on this topic, as well as data obtained
from the Tennessee Department of Health, and debated the merits and potential
detriments of a statewide screening program. The estimated incidence of critical
congenital heart disease is 170 in 100000 live births, and of those, 60 in
100000 infants have ductal-dependent left-sided obstructive lesions with the
potential of presentation by shock or death if the diagnosis is missed. Of the
latter group, the diagnosis is missed in ~9 in 100 000 by fetal ultrasound
assessment and discharge examination and might be identified by a screening
program. Identification of the missed diagnosis in these infants before
discharge could spare many of them death or neurologic sequelae. Four major
studies using pulse oximetry screening were analyzed, and when data were
restricted to critical left-sided obstructive lesions, sensitivity values of 0%
to 50% and false-positive rates of between 0.01% and 12% were found in
asymptomatic populations. Because of this variability and other considerations,
a meaningful cost/benefit analysis could not be performed. It was the consensus
of the task force to provide a recommendation to the legislature that mandatory
screening not be implemented at this time. In addition, we determined that a
very large, prospective, perhaps multi-state study is needed to define the
sensitivity and false-positive rates of lower-limb pulse oximetry screening in
the asymptomatic newborn population and that there needs to be continued
partnering between the medical community, parents, and local, state, and
national governments in decisions regarding mandated medical care.
Progress as of 06/11/07
Thanks to TOF survivor
Representative Doug Overbey a bill passed in Tennessee to study the
effectiveness of pulse oximetry screening for newborns in a pilot project at
hospitals in one of the grand divisions of Tennessee. Tennessee Bill Passed
on June 11, 2007
Click here to view the bill.
To get a bill like this passed your state print the bill and send it to your
state senators and representatives along with a letter asking for them to
follow in Tennessee's footsteps.
It may take a lot of little steps but together we can make sure that no
child leaves the hospital without being tested.
Progress as of 10/10/07
1) Screening is occurring at the following sites: Vanderbilt, Centennial,
Southern Hills, Summitt, Sumner Regional, University Medical Center in
Lebannon, and Medical center in Livingston
2) Hendersonville and Cookeville have equipment and are waiting for their
hospitals legal review
3) Wednesday Dr. Walsh will be visiting Bedford County, Harton
Regional and River Park
4) On the 10th there will be a visit to Williamson County,
Lincoln Memorial, Hillside and Maury Regional
Progress as of 1/24/08
This pilot is being run by Dr. W. Walsh at Vanderbilt. There are 25
middle Tennessee hospitals participating. Baptist Hospital of Nashville and
Cookeville Regional Hospital chose not to participate. Initial
implementation challenges were overcome but time consuming. Many folks
wanted to view this pilot as a "research study" versus a public health
initiative. Administrative issues between VUMC and the other 24 hospitals
also posed some challenges.
It is too early to report meaningful or complete data. We need approximately
15,000 babies to be screened to be able to report meaningful data upon which
to make any type of recommendation. I anticipate a full report in October
which would represent about a full years worth of data. At that time, we
should be in a better position to make appropriate recommendations.
