"Past concerns about test reliability and the incidence of false-positive tests have been largely laid to rest," he said in an interview. "The AAP/AHA/ACC work group report specifies a protocol and management algorithm that appears to be practical, cost effective, and useful for detecting complex congenital heart lesions that may have a subtle presentation in the first 48 hours of life."
He noted that the New Hampshire legislature is considering similar legislation, known as Parker’s Law, and expects that it will receive very strong support from the medical community. Three states – New Jersey, Maryland, and Indiana – have already passed legislation requiring pulse oximetry screening of all newborns. The Maryland law will not take effect until there are federal recommendations for such screenings.
The work group called on the AAP, AHA, and ACCF to work with the American Medical Association to develop appropriate CPT codes for billing and insurance reimbursement. Current CPT codes for pulse oximetry are only appropriate when accompanied by a diagnostic code for a pulmonary disease associated with hypoxia.
Cost estimates for pulse oximetry compare "quite favorably" with cost estimates for newborn hearing screening, according to the work group. Moreover, Swedish researchers calculated that the savings in health care costs from the prevention of one case of complications of circulatory collapse resulting from undiagnosed CCHD may exceed the cost of screening 2,000 newborns (BMJ 2009;338:a3037).
Finally, the work group recommended the development of a national clearinghouse and technical assistance center, similar to the National Resource Center for Newborn Hearing Screening, to coordinate implementation and evaluation.
"The described infrastructure required to support implementation and compliance with screening guidelines is clearly necessary," editorialists Dr. Cuzzi and Ms. Bradshaw wrote. "However, not all hospitals should feel the need to wait until such infrastructure has been developed. Evidence-based tool kits are already available to facilitate implementation."
Dr. Kemper and his associates, Dr. Cuzzi and Ms. Bradshaw, and Dr. Johnson reported no relevant financial disclosures.