A Novel, More Efficient, Staged Approach for Critical Congenital Heart Disease Screening

OBJECTIVE: Screening for critical congenital heart disease (CCHD) using pulse oximetry has been endorsed by the AAP and the AHA. The recommended screening requires two saturation readings. We sought to determine the incidence of undetected CCHD in Tennessee for the two years following implementation of an algorithm that assigned an immediate pass to a single lower extremity saturation of 97% or higher. STUDY DESIGN: 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. RESULT: During the study, 232 infants failed the screen with 51 or 22% true positives, 13 infants had undetected CCHD (10 coarctations, 2 Anomalous veins, 1 Tetralogy of Fallot). CONCLUSION: This approach eliminated over 150,000 pulse oximetry determinations in Tennessee without affecting the ability of pulse oximetry to detect CCHD before discharge.