ABSTRACT
Objectives. Newborn screening for critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel in 2011, and states have been gradually adding pulse oximetry as point-of-care screening to panels. Few data are available on the effectiveness of pulse oximetry as a mandated screening. This study describes outcomes of the first year of screening in Maryland. Methods. A web-based data collection tool for screening results and outcomes, eScreener Plus, was utilized. Data collected from the start of screening from September 1, 2012, to December 31, 2013, were analyzed. Well-baby nursery data were evaluated separately from neonatal intensive care unit (NICU) data to determine whether setting influenced effectiveness. Results. In the first 15 months of newborn screening for CCHD in Maryland, 4 asymptomatic infants were diagnosed with a critical cardiac condition by newborn screening. Eleven infants passed but were later identified with a primary or secondary target condition. Seventy-one percent of infants with CCHD were identified prenatally or by clinical signs and symptoms. Pulse oximetry screening for CCHD had a specificity of more than 99% in both the well-baby nursery and the NICU. Sensitivity in the well-baby nursery was 10% and 60% in the NICU. Conclusion. Further investigation and interpretation of specific protocols that were used and outcomes of screening is needed for continued refinement of the well-baby algorithm and NICU protocol development. Pulse oximetry screening in newborns provides valuable clinical information, but many infants with CCHD are still not identified with current protocols.
ABSTRACT
The prevalence of obesity among children and adolescents in the United States tripled during 1980-2008 and plateaued during 2008-2010. This rise in obesity was associated with a rise in chronic conditions previously observed mostly in adults, including hypertension, hypercholesterolemia, and type 2 diabetes. In 2007, the American Academy of Pediatrics published Expert Committee recommendations for universal screening for overweight and targeted laboratory screening for metabolic disorders among children and adolescents with a body mass index (BMI) at or above the 85th percentile based on age or presence of certain risk factors. To assess the prevalence of overweight and obesity among children and teens enrolled in Maryland Medicaid or the Maryland Children's Health Program (MCHP) and whether or not the children were being screened for obesity-related conditions according to the Expert Committee recommendations, investigators from the Maryland Department of Health and Mental Hygiene computed BMI percentiles for age and sex on a random sample of persons aged 2-19 years enrolled in Maryland Medicaid or MCHP whose height and weight were measured during a well-child visit. Encounter records were used to identify obesity-related conditions and screening laboratory tests received. This study found that 16.5% of participants were overweight (BMI in the 85th-94th percentiles) and 21.4% were obese (BMI at or above the 95th percentile). Obesity was highest among those aged 12-19 years (25.6%) and among Hispanics (28.1%). The diagnosis of obesity-related conditions increased significantly with increasing BMI, with 33.5% of obese participants diagnosed with asthma, 7.9% diagnosed with dyslipidemia, and 7.2% diagnosed with depression. Only 29.9% of overweight and 40.2% of obese participants received a lipid panel test. The results of this investigation were communicated to pediatric, public health, and managed-care leaders. Efforts to communicate the need to increase obesity screening and laboratory testing among this population should continue.
