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Critical Congenital Heart Defect & Pulse Oximetry Screening: A Public Health Law Opportunity

posted on Wed, Nov 28 2012 9:56 am by Chris Walker


It’s always gratifying to see laws and regulations catch up to the science of public health. The legal process can often take years, if evidence-based public health policy is implemented at all, and the delay can be a tremendous cost to health and life. At the National Public Health Law Conference in October, I had the opportunity to pitch a public health legal or policy intervention to a panel of experts about Critical Congenital Heart Defect (CCHD) screening.

CCHD is an umbrella term for seven congenital heart defects that are dangerous to newborn infants. These defects can cause serious disabilities or even death if not treated shortly after birth. Fortunately, there is a relatively cheap method of screening newborns that has been shown to be effective.

Pulse oximetry screening is a non-invasive, low-cost procedure that allows a doctor to use light sensors to measure how much oxygen is in the blood of a newborn. The procedure can be used to better screen newborn children for certain heart diseases that result in lower levels of blood oxygen.

After studies showing that pulse oximetry was effective at identifying newborns with CCHDs before they become symptomatic, the American Academy of Pediatrics (AAP) began the process of encouraging AAP state chapters to work with health departments and legislatures to ensure mandatory, universal coverage. Newborn screening is regulated by the states and the federal government only has an advisory role.

The Department of Health and Human Services (DHHS) went as far as they could by adopting pulse oximetry screening for CCHD into the Recommended Universal Screening Panel in 2011. Any further action has to come from the states themselves, either in the form of new legislation, new regulations, or through executive order.

Most states that have adopted universal CCHD screening have done so through express legislative authorization. This can be a longer, more intensive process, even though CCHD screening isn’t a very politically divisive issue. Many other states could use already established newborn screening powers and simply make new regulations that require pulse oximetry screening. Virginia even adopted universal CCHD screening through the use of an executive order by the governor.

It’s startling that only about a fifth of the states have adopted CCHD screening, considering the variety of ways it can be accomplished and the effectiveness of pulse oximetry. This is a tremendous opportunity for an effective, inexpensive, and politically acceptable public health intervention.

Learn more about CCHD screening laws in various states by viewing this resource.

This blog was prepared by Chris Walker, J.D., Staff Attorney at the Network for Public Health Law -- Northern Region at the William Mitchell College of Law.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this blog do not represent those of the Robert Wood Johnson Foundation.

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