American Academy of Pediatrics Updates Screening Recommendations for Critical Congenital Heart Disease

Pediatricians can build on the success of life-saving advances such as use of pulse oximetry in baby’s first hours of life.

ITASCA, IL--The American Academy of Pediatrics has updated screening recommendations for newborn critical congenital heart disease, a birth defect that causes the highest number of deaths in infants younger than 1 year due to congenital malformations.

The clinical report, “Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations,” endorses a simplified screening algorithm, more uniform reporting of data nationally and other updates for health care providers.

The clinical report, published in the January 2025 Pediatrics (published online Dec. 16, 2024) addresses key developments since screening using pulse oximetry was added to the U.S. Recommended Uniform Screening Panel in 2011. Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.

“The use of a simple bedside test, pulse oximetry, estimates the amount of oxygen in the baby’s blood and has become a lifesaver for infants born with critical congenital heart disease,” said Matthew E. Oster, MD, MPH, FAAP, a lead author of the clinical report and pediatric cardiologist at Children’s Healthcare of Atlanta. The report was written by the AAP Section on Cardiology and Cardiac Surgery, Section on Hospital Medicine, and the Committee on Fetus and Newborn.

“This clinical report builds on the landmark achievements the medical field has accomplished in screening infants for heart defects, and it identifies ways to improve education for health care providers.”

At the state level, screening policies are associated with decreased infant mortality and decreased emergency hospitalizations attributable to critical congenital heart disease. One study found that, compared with prior periods and compared with states that did not have screening policies, early infant deaths from critical congenital heart disease decreased by 33% after states implemented mandatory CCHD screening.

Roughly eight in 1,000 infants have CHD, while critical forms of CHD, or life-threatening CCHD, impact roughly two to four of every 1,000 births. The use of pulse oximetry screening for asymptomatic newborns at or around 24 hours of life helps identify at-risk infants, allowing them to receive lifesaving interventions prior to hospital discharge.

A pulse oximeter is attached to the newborn’s right hand and either foot to measure blood oxygen level. Infants who do not pass the screen undergo further evaluation to determine if they have a serious heart defect.

Screening works best in conjunction with prenatal ultrasound and newborn physical examination. When performed together, roughly 95% of infants with CCHD are detected prior to hospital discharge.

The AAP recommendations include:

• Use a simplified CCHD screening algorithm that eliminates a second rescreen if a newborn falls into the retest category, allowing for earlier intervention. The algorithm also changes the oxygen saturation requirement for passing the screen from 95% or greater in the hand or foot to 95% or greater in the hand and foot.
  While the number of false positives may increase slightly, screening may detect noncardiac conditions such as sepsis and pneumonia that benefit from early identification and treatment.
• Pediatricians should be aware that for each case of critical congenital heart disease that are identified, there typically are four to five cases of infections or respiratory causes of low oxygen saturation.
• Pediatricians should not rely on screening with pulse oximetry alone to determine whether an infant has critical congenital heart disease.
• Public health programs should look for ways to improve data collection, data sharing and improved access to care. Implementing electronic data exchanges and strengthening collaborations between birth hospitals and public health programs are essential to understanding and improving CCHD outcomes.

Screening newborns with pulse oximetry has also helped medical experts identify noncardiac conditions such as sepsis and pneumonia.

“The earlier we can detect these conditions, the earlier we can treat and monitor the baby during these first days of life,” said Gerard R. Martin, MD, MACC, FAHA, FAAP, senior author of the clinical report and pediatric cardiologist at Children's National Hospital.

“The timely coordination of care saves lives and has proven to be cost-efficient. The routine and uniform use of screening at every medical center is essential as we learn more about critical congenital heart disease.”

To request a copy of the embargoed clinical report or an interview with an expert, contact AAP Public Affairs.

• Resources for clinicians: https://www.aap.org/en/patient-care/congenital-heart-defects/newborn-screening-for-critical-congenital-heart-defect-cchd/
• Resources for parents: https://www.healthychildren.org/English/ages-stages/baby/Pages/Newborn-Pulse-Oximetry-Screening-to-Detect-Critical-Congenital-Heart-Disease.aspx

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.