Newborn Screening for Congenital Heart Disease

Testimony by Michael Speer, MD

House Public Health
House Bill 740 by Rep. Myra Crownover
March 13, 2013

Good day, Chair Kolkhorst and members of the committee. I’m Michael Speer, MD, president of the Texas Medical Association representing 47,000 physician and students. I’m also neonatologist and medical director of the Neonatal Nurse Practitioner Program at Texas Children’s Hospital in Houston. In addition, I’m a professor of pediatrics and ethics at Baylor College of Medicine and serve on the state’s Newborn Screening Advisory committee. Today I’m testifying in support of House Bill 740.

First, I want to thank Representative Crownover for her years of leadership on issues surrounding newborn screening. She is a real champion of newborns and their families. This new bill would allow for the newborn screening program to include a hospital-based screen for critical congenital heart diseases. The committee substitute clarifies language to ensure the screening would be carried out at all birthing facilities. It was our pleasure to work with Representative Crownover on substitute language for the bill. We appreciate the fact the committee substitute for HB 740 does not dictate the practice of medicine by determining the specific test that must be performed for individual care situations and varying practice settings.

Texas physicians believe appropriate screening for critical congenital heart conditions can lead to earlier diagnosis of certain conditions and better outcomes for Texas infants. One such type of screening is using a pulse oximetry test to measure the oxygen saturation of hemoglobin in the newborn’s arterial blood. This can help determine if a newborn has certain structural heart defects, which may require some type of intervention, including surgery. These critical congenital heart diseases account for an estimated 17-31 percent of all congenital heart disease.[1]  

States designate which disorders to screen for as part of a statewide newborn screening program. They are guided by the recommended screening panel put forward by the national Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children Screening. Currently Texas newborns are screened for 29 disorders on the panel along with congenital hearing loss. With the addition critical congenital heart disease, HB 740 would align state law with the current recommendations for newborn screening.

Screening for the genetic disorders is largely carried out at the state laboratory, but, like for hearing screening, screening for heart diseases would require a physiologic test delivered outside the laboratory and at the hospital. And for congenital heart disease screening, positive screens would require additional testing before a newborn left the hospital.

We believe the statewide Newborn Screening Advisory Committee can serve an important role as Texas expands to include screening for critical congenital heart screening. The committee is in an ideal position to review and make recommendations regarding standardized implementation of congenital heart screening. The Texas Legislature created the Newborn Screening Advisory Committee in 2009. The group of physicians, parents, and hospital staff is tasked with advising the department on planning, policy, and rules related to newborn screening.   

In light of other testimony provided on HB 15 today, we would like to ask that quality feedback reporting also be considered for critical congenital heart disease screening tests. This would help the state to evaluate the testing methods and timing of the screenings.  

In closing, I again thank you Madame Chair, members of this committee, and Representative Crownover for the opportunity to discuss newborn screening and HB 740. Please allow me to answer any other questions you may have for me at this time.   

  [1] Knapp, AA, Metterville, DR, Kemper, AR, Prosser, L, Perrin, JM. Evidence review: Critical congenital cyanotic heart disease, Final Draft, September 3, 2010. Prepared for the Maternal and Child Health Bureau, Health Resources and Services Administration. 

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