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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
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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: [email protected]
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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
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Copyright
© Cambridge University Press 2017 

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Footnotes

*

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

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