A novel, more efficient, staged approach for critical congenital heart disease screening

Screening for critical congenital heart disease (CCHD) using pulse oximetry has been endorsed by the American Academy of Pediatrics and the American Heart Association. The recommended screening requires two saturation readings. We sought to determine the incidence of undetected CCHD in Tennessee for the 2 years following implementation of an algorithm that assigned an immediate pass to a single lower extremity saturation of 97% or higher.

State Genetic Screening records and reports of missed cases from the Tennessee Initiative for Perinatal Quality Care were used to determine if CCHD cases were missed by the new screening algorithm.

During the study, 232 infants failed the screen with 51 or 22% true positives, 13 infants had undetected CCHD (10 coarctations, 2 anomalous veins and 1 Tetralogy of Fallot).

This approach eliminated over 150 000 pulse oximetry determinations in Tennessee without affecting the ability of pulse oximetry to detect CCHD before discharge.