Welcome to the training on Critical Congenital Heart Disease provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and others to perform state-mandated newborn screening for critical congenital heart disease (CCHD), evaluate results, and provide appropriate follow-up.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Specify the purpose and components of state-mandated newborn pulse oximetry screening for critical congenital heart disease (CCHD).
- Integrate CCHD screening into routine newborn care and provide appropriate follow-up and referrals based on screening results.
Note: This training contains information that is particularly significant to: 1) physicians who treat newborns in birth facilities, 2) physicians in primary care and in subspecialty settings, and 3) nurses and allied health professionals who conduct the CCHD screening in birth facilities and other health-care settings. Some information is more relevant to those who conduct the screening. Testing will be on content that is tailored to both audiences. References to parents in this module also imply guardians or caregivers.
Please note this module expires on 7/23/2022.
This module was released on 7/23/2019.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
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American Academy of Pediatrics. (2018). State Advocacy Focus: Newborn Screening for Critical Congenital Heart Disease.
American Academy of Pediatrics. (2017). The Care of Children With Congenital Heart Disease in Their Primary Medical Home. Pediatrics, 140(5):e20172607.
American Academy of Pediatrics. (2016). Newborn Screening for CCHD: Answers and Resources for Primary Care Pediatricians.
American Academy of Pediatrics. (2013, reaffirmed 2016). Planned Home Birth. Pediatrics, 131(5):1016-1020.
American Academy of Pediatrics. (2012). Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatrics, 129(1): 190-192.
American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
Diller, C. L., Kelleman, M. S., Kupke, K. G., Quary, S. C., Kochilas, L. K., & Oster, M. E. (2018). A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry. Pediatrics, 141(5).
Ewer, A. K. (2013). Review of pulse oximetry screening for critical congenital heart defects in newborn infants. Current Opinion in Cardiology, 28(2), 92-96.
Garg, L. C., Van Naarden Braun, K., Knapp, M. M., Anderson, T. M., Koppel, R. K., Hirsch, D., … Kemper, A. R. Results From the New Jersey Statewide Critical Congenital Heart Defects Screening Program. Pediatrics, 132(2), e314-e323.
Centers for Disease Control and Prevention. (2019). Actions in Support of Newborn Screening for Critical Congenital Heart Disease — United States, 2011–2018. MMWR Morbidity and Mortality Weekly Report, 68:107–111.
Gong, A., Guillory, C., Creel, L., Livingtson, J. E., McKee-Garrett, T-M., & Fortunov, R. (2017). A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units. American Journal of Perinatology, 34(09): 839-844.
Kemper, A. R., Mahle, W. T., Martin, G. R., Cooley, W. C., Kumar, P., Morrow, W. R., … Howell, R. R. (2011). Strategies for implementing screening for critical congenital heart disease. Pediatrics, 128(5), e1259-e1267.
Knapp, A. A., & Metterville, D. R. (2010). Evidence Review: Critical Congenital Cyanotic Heart Disease. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.
Lees, M. H. (1970). Cyanosis of the newborn infant. Recognition and clinical evaluation. Journal of Pediatrics, 77: 484.
Mahle, W. T., Newburger, J. W., Matherne, G. P., Smith, F. C., Hoke, T. R., Koppel, R., American Heart Association, & American Academy of Pediatrics. (2009). Role of pulse oximetry in examining newborns for congenital heart disease: A scientific statement from the AHA and the AAP. Pediatrics, 124(2):823-36.
Martin, G. R., Beekman, R. H., Fasules, J., Garg, L. F., Kemper, A. R., Mahle, W. R., … Pearson, G. D. (2013). Implementing recommended screening for critical congenital heart disease. Pediatrics, 132, e185-e192.
March of Dimes. (n.d.). Fact Sheet: Support Screening for Critical Congenital Heart Disease (CCHD) as part of the state newborn screening panel.
Oster, M. (2019). Newborn screening for critical congenital heart disease using pulse oximetry. UptoDate, Feb. 11, 2019.
Peterson, C., Dawson, A., Grosse, S. D., Riehle-Colarusso, T., Olney, R. S., Tanner, J. P., … Cassell, C. H. (2013). Hospitalizations, Costs, and Mortality among Infants with Critical Congenital Heart Disease: How Important Is Timely Detection? Birth Defects Research, 97(10), 664-672.
Plana M. N., Zamora J., Suresh G., Fernandez-Pineda L., Thangaratinam S., & Ewer, A.K. (2018). Pulse oximetry screening for critical congenital heart defects. Cochrane Database of Systemic Reviews, No. 3.
Samuel, T. Y., Goldberg, S., Lahav, S., Mandel, D., Mimouni, F. B., Picard, E., & Bromiker, R. (2013). Newborn oxygen saturation at mild altitude versus sea level: implications for neonatal screening for critical congenital heart disease. Acta Paediatrica, 102(4), 379-384.
Schultz, A. H., Localio, A. R., Clark, B. J., Ravishankar, C., Videon, N., & Kimmel, S. E. (2008). Epidemiologic features of the presentation of critical congenital heart disease: implications for screening. Pediatrics, 121(4):751-7.
Texas Department of State Health Services. (2014). Newborn Screening for Critical Congenital Heart Disease in Texas.
Texas Pulse Oximetry Project. (2013). Video on CCHD.
U.S. Department of Health and Human Services, Agency for Healthcare Research. (2013). Transitioning Newborns from NICU to Home: A Resource Toolkit.
U.S. Department of Health and Human Services, Health Resources and Services Administration. (2015). U.S. Recommended Uniform Screening Panel.
West Virginia Perinatal Partnership. (n.d.). Critical Congenital Heart Disease Screening Program Toolkit, 4th Edition.
The medical definitions provided in this module were adapted or obtained from the federal Health Resources and Services Administration; the University of California, San Francisco; the U.S. National Library of Medicine; and WebMD.
American Academy of Pediatrics. (2013, reaffirmed 2016). Policy Statement: Planned Home Birth.
American Academy of Pediatrics. (2011). Policy Statement: Strategies for implementing screening for critical congenital heart disease.
American Academy of Pediatrics. (2019). Newborn Screening: Critical Congenital Heart Defects: Answers and Resources for Primary Care Pediatricians.
Critical Congenital Heart Disease and the NICU:
Manja, V., Mathew, B., Carrion, V., & Lakshminrusimha, S. (2015), Critical Congenital Heart Disease Screening by Pulse Oximetry in a Neonatal Intensive Care Unit. Journal of Perinatology, 35(1): 67–71.
Murphy, D., Pak, Y., & Cleary, J. P. (2016), Pulse Oximetry Overestimates Oxyhemoglobin in Neonates with Critical Congenital Heart Disease. Neonatology, 109(3):213-8.
Texas Pulse Oximetry Project’s CCHD Toolkit. It includes an algorithm card, bilingual informational brochures for families, and sample screening log.
Texas Department of State Health Services. Newborn Screening for Critical Congenital Heart Disease in Texas web page with resources.
Texas Medicaid & Healthcare Partnership. Online Provider Lookup.
U.S. Department of Health and Human Services, Agency for Healthcare Research Quality (AHRQ). Toolkit to help improve the safety of fragile newborns with complex congenital conditions as they transition from the NICU to home.
Baby’s First Test. CCHD information and videos.
Texas Department of State Health Services. Critical Congenital Heart Disease bilingual Parent Education Brochures.
Texas Department of State Health Services. Texas Health Steps, information about finding a health-care provider and getting a ride to a checkup.
Texas Health and Human Services Commission. My Children’s Medicaid website, information for families about Medicaid benefits and pediatric health-care services.
Texas Pulse Oximetry Project. Video on CCHD.
Utah Department of Health. FAQs and other CCHD information for families.
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