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. 2020 Mar 14;6(1):21. doi: 10.3390/ijns6010021

Table 2.

POS implementation efforts in some Latin American countries: Summary of results.

Country and Region Births per Year POS Challenges Others Comments Law
Argentina*# 685,394 Variable Urgent need for further expansion of POS in the nation

  • Inter-center disparity in neonatal outcomes

  • Approximately 7000 children are born every year with CHD

 National Congenital Heart Disease Program was created to coordinate referral, transfer, treatment, and follow-up of children without insurance coverage with CHD
Buenos Aires City 34,640 Intermittent, variability Lack of equipment (pulse oximeters) and the low availability of nursing h in rooming-in areas of the maternity hospitals Less compliance in maternities of the private sector Projects to incorporate CCHD in the mandatory list in the Neonatal Screening National Law # 26,279
San Luis 4000 YES The high cost of the non-reusable sensors. In addition, early discharge of both vaginal and caesarean section births

  • Full implementation has been achieved for the early detection of hypoxemic conditions, not only CCHD, for 6 months.

  • Four cases (Not CCHD) detected/1400

 NO
Rosario 22,000 YES, partial Resistance, no acceptance of the added clinical value of POS, and lack of support for the program. This is worse during weekends and holidays Since mid 2019, POS is being performed in all public hospitals, but in only one private institution. Some private hospitals that do not perform POS refer all healthy infants to pediatric cardiology, where an evaluation is done to rule out CCHD (with charges) NO
Bolivia*# 243,000 NO Lack of specialists, and costs for the implementation of programs that can solve complex problems<break/>CHD affects 9‰ live births and 25% need surgery during the first year of life Some centers have algorithms for the early detection of CCHD. The lack of personnel and equipment, together with the non-resolution of the problems detected, have caused this to fail NO. Bolivia does not have any program designed by the Ministry of Health for the detection and treatment of CCHD or POS
Chile 250,000 Intermittent, variability The main difficulties have been the lack of equipment and supplies and the shortage of available h of trained professionals (nurses) for POS CHD affects 9‰ live births and 25% need surgery during the first year of life NO. Chilean health reform (2003-5): prenatal screening and a care network centralizing the surgical resolution
Colombia* 650,000 YES, in some cities. There are only six centers performing POS in the nation Although early detection is cost effective, treatment and follow-up are still very expensive for the economic reality of Colombia’s health system Barranquilla started the first POS program in the country. Over 9240 screened, 20 true positive cases, 12 had various types of CCHD (see Table 1), and 8 had other hypoxemic conditions Mandatory POS for complex congenital heart disease in the immediate neonatal period in Resolution 3280 of 2018
Costa Rica* 65,000 YES The biggest challenges have been related to the decision of who should perform POS In 33,804 births, 16 infants with CCHD were detected early. A similar number was found to have other hypoxemic conditions early, mainly PPHN and sepsis. POS established in all public and private health centers in the country since 2016, performed between 12 and 24 h of age for all healthy newborns
Cuba*# 117,000 Intermittent in few neonatal centers Limited number of sensors available, monitors frequently used to care for critically ill neonates in NICU For CCHD diagnosis, most newborns in Cuba rely on findings of universal prenatal ultrasounds and physical exams In Cuba, abortion has been legalized. Fetal ECHO is performed in over 99% of pregnant women; when a fetus is diagnosed with serious CHD, pregnancy is terminated in many cases
El Salvador* 91,000 NO

  • Technical-financial support for implementation

  • Resistance, lack of interest, or no positive attitudinal behavior for accepting and making changes

 Hospital Nacional de la Mujer and Social Security Institute plan to start universal POS by the last trimester of 2020. NO
Guatemala*# 486,497 NO Low interest of the health system and of the professionals who care for newborns Only one public health hospital and one private hospital established a cardiac screening program, following SIBEN’s Clinical Consensus NO
Honduras*# 150,000 Partial and irregular in one neonatal center

  • Technical-financial support for implementation

  • Insufficient staff and equipment

  • Human factors

 Hospital Escuela (70 births/day) starts irregularly in 2017 with SIBEN support: Seven CCHD detected in 1221 NB. Reports a decrease in the average age at which heart patients receive interventions: In 2017, 13% of cases were newborn infants; in 2018, this increased to 18%; and in 2019, this increased to 24% NO
Mexico* 2,500,000 Wide disparities exist in the delivery of health care in general and about POS in particular 135,000,000 inhabitants SIBEN has consulted with Senate Health Commission for the possible addition of POS to Article 61 of the National Health Law. Passed the Senate Health Commission. Now in House of Representatives
Mexico city Intermittent, irregular, and sporadic. City with the largest population in the Americas Several private centers have started POS, but at a cost to the family
Sonora YES Four hospitals have a universal POS program: in two of them, there is a charge per test One of the states where more public hospitals perform POS: 9181 infants have been screened, 22 tested + (11 CCHD, 8 PPHN and 2 sepsis)
Guadalajara NO, irregular and inconstantly Lack of infrastructure, pulse oximeters and/or consumables (sensors). Limited commitment of neonatal health care professionals There is no extra charge for POS in private institutions
San Luis de Potosí NO, only one center Lack of established protocols and monitors. Few hospitals where neonatal cardiovascular surgery is performed
Paraguay* 110,000 In only one neonatal center

  • RN staffing on weekends

  • Insufficient equipment: MDs, on occasion, take the SpO2 monitor to the NICU

 Hospital de Clínicas, Facultad de Ciencias Médicas-Universidad Nacional de Asunción starts POS with SIBEN’s support NO
Perú*# 560,000 YES, in INMP Lima. Variable in other centers and regions Lack of adequate and permanent coverage and not all of them had an appropriate monitor. POS is starting at some institutions of the Ministry of Health National Technical Standard for POS was issued (INMP and SIBEN’s support) NO, Neonatal Screening Law (Number 29,885). POS not included
República Dominicana*# 200,000 NO All neonatal nurses were unaware about POS. There were not enough saturation monitors and sensors and the ones available did not meet the standards. In 2019, started education for early detection of CCHD with POS, utilizing SIBEN’s clinical consensus. NO, CCHD represents the fourth leading cause of neonatal mortality in this country.

* SIBEN Educational Programs for MDs and RNs and Clinical Consensus on POS; # SIBEN donation of SpO2 monitors and sensors.