Congenital Heart Disease (CHD) is a common birth defect affecting 10/1000 babies in the United States each year. Of these babies, 25% will have critical congenital heart disease (CCHD). While infants with CCHD may be identified by prenatal ultrasound, many cases of CCHD are discovered after birth. Unfortunately, changes in the structure and function of the newborn heart can lead to CCHD going unrecognized during the newborn hospital stay. In 2011 the United States Secretary of Health and Human Services recommended adding pulse oximetry screening for CCHD to the Universal newborn screening panel. The goal of universal pulse oximetry screening in the newborn period is to identify infants with asymptomatic critical congenital heart disease and prevent morbidity and mortality in these babies.
While infants with CCHD can have a normal physical exam in the immediate newborn period with no heart murmur and no clinical cyanosis, most will have hypoxemia. Advances in pulse oximetry have improved the accuracy of this test in identifying hypoxemia in newborns and allowed it to be used as a screening test for CCHD. In asymptomatic infants, pulse oximetry can complement the clinical exam in the detection of CCHD by identifying clinically undetectable hypoxemia.
- All babies cared for in the newborn nursery will be screened for CCHD between 24 and 48 hours of life using pulse oximetry to detect hypoxemia. The screening test can be thought of as a “two sites, three strikes” screen. Pulse oximetry is done at two sites, the right hand and either foot. Screening on the right hand and one foot provides both pre and post ductal oxygen saturations. An infant must fail three consecutive measurements spaced one hour apart, or have “three strikes,” to have failed the screen (with the exception of an oxygen saturation <90% in either extremity which would be an immediate failed screen.).
- An infant will PASS screening if the oxygen saturation is ≥95% in either the hand or the foot with ≤ 3% difference between extremities.
- An infant will FAIL screening if the oxygen saturation is <95% in both the hand and the foot, or if there is a >3% difference between the extremities on three separate measures each separated by one hour.
- An infant will FAIL screening if the oxygen saturation is <90% in either the hand or the foot at any time.
Infants who fail screening will need further evaluation in the nursery prior to discharge. It is recommended that infants who fail screening have an echocardiogram to rule out structural heart disease.
Screening for CCHD with pulse oximetry has been shown to be cost effective, accurate, and easy to incorporate into the workflow of the normal newborn nursery.
Thank you for your support in screening newborns for CCHD. Please contact us with any questions regarding the screening process.