A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry.

Area of Science:

• Neonatal screening
• Pediatric cardiology
• Public health

Background:

• Critical congenital heart disease (CCHD) screening is vital for early detection and intervention in newborns.
• The American Academy of Pediatrics (AAP) developed a screening algorithm to identify infants with CCHD.
• Evaluating the performance of the AAP algorithm is crucial for optimizing newborn health outcomes.

Purpose of the Study:

• To determine the performance of the AAP CCHD newborn screening algorithm.
• To assess the impact of a modified screening algorithm on detection rates and false positives.
• To identify potential improvements in CCHD screening protocols.

Main Methods:

• A retrospective review of screening data from term infants at a tertiary birth hospital (2013-2016).
• Analysis of true- and false-positives and true- and false-negatives using the AAP algorithm.
• A simulation study to model a modified algorithm with a single repeat pulse oximetry test.

Main Results:

• The AAP algorithm screened 77,148 newborns, with a sensitivity of 14.3% and a specificity of 99.96%.
• The current algorithm resulted in 1 true-positive, 33 false-positives, and 6 false-negatives.
• A modified algorithm showed similar sensitivity but a slightly increased false-positive rate (0.054%).

Conclusions:

• The AAP CCHD screening algorithm in a tertiary care setting may not detect many CCHD cases but can identify other significant newborn diseases.
• Modifying the algorithm to allow one repeat pulse oximetry test could detect more infants with significant conditions.
• This modification may enhance disease detection without a substantial rise in false-positive results.