Mandatory Screening for Congenital Heart Disease: Effects on Infant Mortality

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Researchers conducted a difference-in-differences analysis on birth and infant death data between 2007and 2013.
Researchers conducted a difference-in-differences analysis on birth and infant death data between 2007and 2013.

Mandatory statewide newborn screening for critical congenital heart disease is associated with a substantial reduction in the number of infant cardiac deaths compared with states that have not enacted such policies, according to findings from an observational study published in JAMA.

Investigators conducted a difference-in-differences analysis on birth and infant death data for 26,546,503 births between 2007 and 2013. The researchers compared states that implemented mandatory screening policies for congenital heart disease in infants with states that did not include these policies. A total of 8 states had mandatory screening policies in place by the study's cut-off year of 2013, whereas 5 states included voluntary screening policies and 9 states had adopted policies but they had not yet been implemented.

During the 6-year study period, 2734 infant deaths occurred due to critical congenital heart disease. In the states with mandatory screening policies in place, the death rates due to critical congenital heart disease were 8.0 per 100,000 births (95% CI, 5.4-10.6; n=37) in 2007 and 6.4 per 100,000 births (95% CI, 2.9-9.9; n=13) in 2013.

Through December 31, 2013, the researchers observed a 33.4% reduction in early infant deaths due to congenital heart disease (95% CI, 10.6%-50.3%) and an absolute decrease of 3.9 deaths per 100,000 births (95% CI, 3.6-4.1) following the mandatory implementation of disease screening. In addition, implementation of mandatory screening policies correlated with a 21.4% decline in infant deaths due to other/unspecified cardiac causes (95% CI, 6.9%-33.7%).

To identify infant deaths, the investigators used ICD-10 codes that may not have been entirely accurate in determining the exact cause of death (eg, critical congenital heart disease vs other conditions). Findings may also have been limited by a lack of data on hospital screening processes within states.

In addition to the overall study findings, the investigators suggested that the lower reduction of early infant deaths observed within the first 24 hours “reflects that screening at 24 hours cannot avert deaths during the first 24 hours.”

Reference

Abouk R, Grosse SD, Ailes EC, Oster ME. Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths. JAMA. 2017;318(21):2111-2118.

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