Running Head: SCREENINGS FOR ALL NEWBORNS

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The Importance of Mandating Congenital Heart Defect Screenings for All Newborns Kayla Vadney Old Dominion University

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The Importance of Mandating Congenital Heart Defect Screenings for All Newborns Since the days of Florence Nightingale, nurses have sought to establish the importance of thorough, individualized and holistic patient care for the ill and injured at the bedside. However, health promotion and disease prevention are becoming increasingly important practices in healthcare in order to decrease unnecessary hospitalizations and improve patient independence. Now more than ever, it is vital that nurses reach out in the community and engage in healthcare politics in order to make changes to further improve patient care and quality of life. The purpose of this paper is to serve as an advocate for healthcare consumers by discussing and analyzing a healthcare issue of political significance to the nursing community. Statement of the Issue The Centers for Disease Control and Prevention (CDC) declare that with almost 40,000 new cases each year, congenital heart anomalies are some of the most commonly occurring birth defects in the United States and are a leading cause of newborn complications and death (2011). In the state of Virginia, there is currently no policy mandating the screening of all newborns for congenital heart defects. This suggests that many babies who appear healthy and are initially asymptomatic are discharged from the hospital, only to require emergent care days or weeks later related to complications from an insufficiently functioning circulatory system. In addition to the more immediate complications, about one-third of infants born with a congenital heart defect will develop subsequent physical or cognitive impairments (CDC, 2011). More specifically, many newborns diagnosed with complex congenital heart abnormalities also have a reduced brain size and/or functioning capacity compared to those without heart defects, according to Limperopoulos et al. (2009). This is important because a lack of sufficient brain volume can contribute to a significantly reduced neurodevelopmental outcome and may serve as a significant

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source of congenital heart defect-related morbidity and mortality (Limperopoulos et al., 2009). In order to address this issue, Bill HB387 (2014) has been submitted to the Virginia House of Delegates and Senate, proposing that every hospital in Virginia implement a protocol that requires the screening of each and every newborn for congenital heart defects, including the use of pulse oximetry, between 24 and 48 hours of life, or before discharge. The bill also declares the need for proper follow-up care to be initiated after a positive test result to minimize complications (HB387, 2014). Position on the Issue Given the seriousness of congenital heart defects and their prevalence in the United States, I am in favor of passing this bill to mandate screenings for all newborns. In some cases, it may take awhile after birth for infants to show signs or symptoms of a cardiac abnormality. Therefore, by routinely screening all newborns before discharge from the hospital, there is a great possibility of quickly identifying a problem in a seemingly healthy newborn and preventing the need for emergent care in the near future. In other words, by identifying an issue early on, it is possible to capitalize on the ability to treat or manage the condition to minimize complications and maximize quality and quantity of life. According to the CDC (2011), in part due to the screening protocols implemented in other states, many individuals born with congenital heart defects now live well into adulthood. Therefore, by implementing a protocol in Virginia, statespecific death rates related to congenital heart diseases will hopefully decrease. In addition to reducing newborn deaths and complications, this bill should be passed also because of how quick and easy it is to complete. Of course, each and every newborn could be thoroughly screened for all the various congenital heart anomalies currently known to modern medicine. However, pulse oximetry, which was mentioned in the bill, is a quick and far less

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invasive practice that can identify the presence of many congenital heart defects. In 2009 Granelli et al. published a study to analyze the effectiveness of pulse oximetry in detecting congenital heart defects on newborns in a well-baby nursery in Sweden over the course of three years. The study found that before the implementation of pulse oximetry, there was an average of 63% effectiveness in accurately detecting heart diseases in newborns. However with examination and pulse oximetry together, that average increased to 83% (Granelli et al., 2009), although detection of each type of abnormality varied in effectiveness. Therefore, by doing something so simple as placing a pulse oximeter on a baby, which would not drastically add to a nurse’s workload, there may be a significant increase in likelihood that an asymptomatic newborn is properly diagnosed and treated. For all of the above reasons, a letter expressing this position was sent to a local Virginian Delegate in an effort to pass Bill HB387 and is included in Appendix A. Conclusion In conclusion, congenital heart defects pose a very serious, life-threatening situation and too many newborns are sent home without being properly screened. Every hospital in the state of Virginia should be required to screen each newborn before discharge and refer families for proper follow-up care as required. In recent years, it has become increasingly important for nurses to broaden their role as patient advocates from the bedside and branch out into the community to benefit all healthcare consumers. If nurses participate in healthcare politics and take the time to fight for patients on a larger scale, many lives can be improved or even saved.

SCREENINGS FOR ALL NEWBORNS References

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Centers for Disease Control and Prevention. (2011). Congenital heart defects. Retrieved from http://www.cdc.gov/ncbddd/heartdefects/index.html Limperopoulos, C., Tworetzky, W., McElhinney, D.B., Newburger, J.W., Brown D.W., Robertson, R.L., … Plessis, A.J. (2009). Brain volume and metabolism in fetuses with congenital heart disease. Circulation, 12(1), 26-33. doi: 10.1161/ Granelli, A., Wennergren, M., Sandberg, K., Melleander, M., Bejlum, C., Inganäs, L.,… Östman-Smith, I. (2009). Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: A Swedish prospective screening study in 39,821 newborns. British Medical Journal, 1-12. doi: 10.1136/bmj.a3037 Virginia. House of Delegates. Newborns; critical congenital heart defect screening. 2014 sess. HB387. Richmond: Government Printing Office. Retrieved from http://lis.virginia.gov/cgi-bin/legp604.exe?ses=141&typ=bil&val=hb387&submit=GO

SCREENINGS FOR ALL NEWBORNS Appendix A Kayla M. Vadney 2008 Cassatt Court Virginia Beach, Virginia 23464 February 2, 2014 The Honorable Ronald A. Villanueva Virginia House of Delegates 1000 Bank Street General Assembly Building Richmond, Virginia 23218 Dear Delegate Villanueva:

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My name is Kayla Vadney and I am a senior baccalaureate-nursing student at Old Dominion University in Norfolk, Virginia. However, I live in your district and hope to obtain employment locally upon graduation. I am writing to request your support in favor of Bill HB387, Newborns; critical congenital heart defect screening which proposes mandating that each hospital implement a screening protocol for all newborns for congenital heart defects and provide follow-up care for those diagnosed with such abnormalities. Although in my education at Old Dominion University I am required to gain experience in a variety of nursing specialties, maternity is my passion and the area I ultimately wish to work in. That being said, I am currently shadowing a nurse on a maternity unit at a local hospital and I spend a lot of time in the nursery with newborn infants. It has come to my attention that in Virginia there is currently no routine screening for congenital heart defects and that in the majority of cases, infants are only screened if there is a family history or other obvious indication. However, according to the Centers for Disease Control and Prevention (CDC; 2011), congenital heart defects make up the most commonly occurring form of birth defect in the United States, with approximately 40,000 cases each year, and is a leading cause of infant death. With so many discovered cases, it is very alarming to me that each and every baby born in our hospitals is not screened. The fact of the matter is that in many cases these individuals are not properly diagnosed until they show symptoms, which at that point can be life threatening and pose several complications (CDC, 2011). This is especially heart wrenching to me because according to the CDC (2011) about one-third of babies born with a congenital heart defect will develop other physical impairments or cognitive delays. Therefore, in addition to helping prevent some unnecessary deaths, screening all newborns and identifying an abnormality early may also help improve the quality of life for survivors by maximizing their physical abilities and minimizing developmental delays so that they may reach their full potential in society. I hope that you will thoroughly consider voting in favor of this bill. However, whatever your decision may be, please notify me via the email provided below. If you have any further questions, please feel free to use me as a resource, or refer to the CDC website, also provided below. Thank you very much for your consideration.

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Centers for Disease Control and Prevention. (2011). Congenital Heart Defects. Retrieved from http://www.cdc.gov/ncbddd/heartdefects/index.html Sincerely, Kayla M. Vadney kvadn001@odu.edu

SCREENINGS FOR ALL NEWBORNS Appendix B

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Below is Delegate Ronald A. Villanueva’s response to the letter in Appendix A and therefore proof of delivery of that letter via email. I acknowledge that Bill HB 387 has been referred to the Committee on Education and Health in the Senate and I have sent them my letter as well, but am still awaiting a response. Mon, Feb 3, 2014 at 8:43 AM Miss Vadney, I want to thank you for reaching out to me regarding your support of HB387 which would require heart screening of newborns. I appreciate you taking the time to express your concerns as I take all of my constituents’ correspondence into consideration. Currently, HB387 has passed in the House, and now is in the Senate and was referred to the Committee on Education and Health. Thanks for contacting my office and participating in the legislative process. I appreciate you reaching out to me. Please continue to visit the General Assembly website at virginiageneralassembly.gov to keep track of this and any other matters of concern to you. With Pride in Our Commonwealth, Ron Office of Ron Villanueva Virginia Delegate, 21st House District Richmond Office 
 (804) 698-1021 phone
 (804) 698-6721 fax
 delrvillanueva@house.virginia.gov

SCREENINGS FOR ALL NEWBORNS Honor Code

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“I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor Code. I will report to a hearing if summoned.” Electronic Signature: ____Kayla M. Vadney___ Date: _2/4/2014__