262258 Determinants of Timely versus Late Postnatal Detection of Infants with Critical Congenital Heart Disease

Tuesday, October 30, 2012 : 11:15 AM - 11:30 AM

April Dawson, MPH , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Cora Peterson, PhD , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Scott Grosse, PhD , National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Tiffany Colarusso, MD , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Richard Olney, MD, MPH , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Jean Paul Tanner, MPH , 4 Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
Russell Kirby, PhD , Maternal and Child Health, University of South Florida, Tampa, FL
Jane Correia, BS , Florida Birth Defects Registry, Florida Department of Health, Bureau of Environmental Public Health Medicine, Tallahassee, FL
Sharon Watkins, PhD , Analytical Environmental Epidemiology Program, Florida Department of Health, Bureau of Environmental Public Health Medicine, Tallahassee, FL
Cynthia Cassell, PhD , National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Background: In 2011, the U.S. Secretary of Health and Human Services approved addition of critical congenital heart disease (CCHD) to the Recommended Uniform Screening Panel to help improve timely postnatal diagnosis and treatment. This project examined factors associated with late CCHD detection. Methods: This was a retrospective, population-based study of infants with 12 CCHD types born 1998-2007 using the Florida Birth Defects Registry and hospital discharge records. A CCHD was “late detected” if no ICD-9-CM code indicative of congenital heart disease was noted in the birth hospitalization record. Multivariable logistic regression was used to determine whether selected sociodemographic and perinatal clinical characteristics (preterm birth, infant sex, presence of other non-cardiac and cardiac defects, CCHD type, payer status, birth hospital nursery level, and maternal age, race/ethnicity, and education) were associated with late CCHD detection. Results: Among 3,652 infants with CCHD, 16% had late detected CCHD. These infants were significantly more likely to have been born in a level I or II nursery compared to a level III nursery. Compared to hypoplastic left heart syndrome, total anomalous pulmonary venous connection, coarctation of the aorta, aortic arch atresia/hypoplasia, and truncus arteriosus were significantly more likely to have been detected late. No other factors examined were associated with late CCHD detection. Conclusions: As expected, CCHD type demonstrated an association with timely detection. The association between a level I or II birth hospitalization nursery and delayed detection suggests that universal newborn screening for CCHD could be particularly beneficial in level I or II hospital nurseries.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Public health or related nursing
Public health or related public policy
Public health or related research

Learning Objectives:
Compare proportion of infants with timely and late detected critical congenital heart disease Identify factors associated with late detection of critical congenital heart disease

Keywords: Birth Defects, Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: April Dawson, MPH, is an epidemiologist in the Birth Defects Branch at the Centers for Disease Control and Prevention (CDC). She has worked in the field of birth defects for several years. She has also worked with and analyzed data from the National Birth Defects Prevention Study, which is the largest case-control study of risk factors for birth defects. She is the lead researcher and analyst for this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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