To: Chief Medical Officers and Chief Nursing Officers
From: Zosia Stanley, Policy Director
Claudia Sanders, SVP, Policy Development
Staff Contact: Zosia Stanley, ZosiaS@wsha.org or (206) 216-2511
Subject: New Requirement to Conduct Congenital Heart Disease Screenings for All Newborns
Purpose
The purpose of this bulletin is to provide an overview of new requirements to perform Critical Congenital Heart Disease (CCHD) screenings for all newborns born in the state. The Washington State Hospital Association (WSHA) supported the change in requirements because the health of newborns is important. We believe all hospitals are currently performing these screens.
Applicability/Scope
The new requirement to screen newborns for CCHD applies to all babies born in any setting in the state, including all hospitals where births occur and all out-of-hospital births. The law establishing this requirement goes into effect on June 24, 2015.
Overview
Critical Congenital Heart Disease (CCHD) is a group of congenital heart defects that can cause life-threatening symptoms. CCHD can include abnormal or absent heart chambers, holes in the heart, or abnormalities in the heart’s function. CCHD is endorsed by the American Academy of Pediatrics and is included in the Recommended Uniform Screening Panel issued by the United States Department of Health and Human Services.
“Critical congenital heart disease” is defined in state law to mean “an abnormality in the structure or function of the heart that exists at birth, causes severe, life-threatening symptoms, and requires medical intervention within the first year of life.” (HB 1285)
The state newborn screening law (RCW 70.83) has been amended to require hospitals to perform CCHD screening using pulse oximetry before an infant is discharged from the hospital in accordance with recommended American Academy of Pediatrics guidelines. The results of the screening test must be recorded in the newborn’s medical record. If the screening indicates suspicion of abnormality, the newborn must be referred to appropriate care and the results reported to the newborn’s attending physician and parent, parents, or guardian. The results of the screening test must be recorded in the newborn’s medical record. If the screening indicates suspicion of abnormality, the newborn must be referred to appropriate care and the results reported to the newborn’s attending physician and parent, parents, or guardian.
Health care providers attending out-of-hospital births are also required to follow the above procedures of mandatory CCHD screening, recording, and notice. However, there is an exception for health care providers. If the health care provider does not have the proper equipment to perform pulse oximetry, the provider may decline to perform the test and must notify the newborn’s parent, parents, or guardian in writing that (a) the provider was unable to perform the test and (2) that the infant should be tested by another health care provider no sooner than 24 hours after the birth, but no later than 48 hours after the birth.
Parents or guardians may object to the screening based on religious grounds.
The change in law was spurred by the fact that the requirements meet national standards, and Washington State was shown on national charts as lacking a mandate, despite all the work that has been done in the state to further newborn screening.
Recommendation
WSHA understands that all hospitals in Washington State currently screen newborns for CCHD. This previously voluntary screening is now mandatory under state law.
WSHA recommends that hospitals review policies and procedures to ensure that CCHD screening occurs prior to newborn discharge and that the results are recorded in the newborn’s medical records.
Next Steps
The Washington State Department of Health will likely engage in rule-making to codify the new law in the Washington Administrative Code in the coming months. WSHA will keep members up to date on this process.
Background and References
HB 1285 (enacting legislation)
