PC2118: The Colombia Global Health Initiative: Critical Congenital Heart Disease (CCHD) Screening Implementation

Background: The global prevalence of Congenital Heart Disease (CHD) at birth is currently estimated to be 1.8 cases per 100 live births. Critical CHD (CCHD), defined as requiring surgical or catheter intervention in the first year of life, occurs in approximately 25% of those with CHD. A large disparity exists in the global capacity to care for these patients. In Colombia, the universal use of pulse oximetry screening (POS) 24 hours after birth is recommended by law. However, there is a significant lag in routine adoption of this practice that leads to a late or missed diagnoses for CCHD.

Methods: We describe our efforts in implementing a program of POS in Colombia. Goal is to impact mortality and morbidity associated with a delayed CCHD diagnosis by accelerating universal adoption of routine newborn cardiac screening protocols. We established an initial goal of screening up to 100,000 newborns within five years of program launch. We deployed an innovative model to enhance access to pediatric cardiovascular care via multisite, multi-city, and multi-regional clinical and educational partnerships. We also provided the necessary capital equipment (11 Pulse Oximeters, 5 Echocardiographs), as well as all related educational and technical training for a total of 192 nurses and 8 physicians. We also contributed with the contractual, legal, and logistical support required to launch the program.

Results: To date we have operationalized 11 CHD screening sites in 4 different regions in Colombia. Despite COVID related delays, 20,000 newborns were screened to date and we foresee meeting the initial target by end of year three. A total of 51 cases of CHD were identified and 8 of them were CCHD requiring immediate surgical intervention. We performed 558 echocardiograms, including other diagnostic settings such as infants of diabetic mother, unexplained cyanosis, respiratory distress, and dysmorphic features. Overall, the percentage of newborns screened at all participating sites is 77% to date. Our qualitative analysis revealed wide regional disparities in patterns of care that exist and the peculiar challenges of each one of them.

Conclusion: We conclude that universal CCHD screening implementation in Colombia has significant value for newborns with CHD and for others with hypoxemic conditions. Our structured programmatic approach was able to successfully address and impact the wide variation in current program adoption observed among different regions. The universal implementation of CCHD screening will be essential for reducing mortality associated with CHD in the future and will not be feasible without the endorsement and support of the government and payors. Our long-term vision is to replicate and scale an optimal program framework to other countries, as well as to expand into other innovative global models of pediatric subspecialty care.