Blood pressure screening for critical congenital heart disease in neonates

Pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in neonates is less effective in identifying aortic arch obstruction than in detecting other forms of CCHD. This study was performed to assess the use of neonatal blood pressure (BP) screening to detect CCHD. A retrospective review of BP and POx measurements performed at the age of 24 h or before discharge in asymptomatic term neonates was undertaken. The charts of infants readmitted younger than 30 days with a diagnosis of CCHD also were reviewed to identify infants with a missed diagnosis. The screening process was completed for 10,012 of 10,436 infants. Because of an abnormal initial result, 164 neonates required a repeat screening (139 due to abnormal BP). A total of 12 infants failed the BP screening component, and 1 infant failed both the BP and Pox components. The average final right arm-to-leg BP gradient was 25 mmHg in these 13 babies. For nine infants, CCHD was excluded by echocardiography. Three patients were normal at their 1-year well-child exam, and one patient was lost to follow-up evaluation. No infants were identified who had been discharged home with a missed diagnosis of CCHD. Neonatal BP screening to detect CCHD was responsible for more inappropriately performed screenings, repeated screenings, and screening failures than the POx component of the screening protocol and had a highest possible positive predictive value of 1 in 13. These data suggests that BP screening at the time of routine newborn hospital discharge is of limited value in the detection of unrecognized CCHD.