Updated strategies for pulse oximetry screening for critical congenital heart disease

Seven years after addition to the United States Recommended Uniform Screening Panel, newborn screening for critical congenital heart disease (CCHD) using pulse oximetry became mandatory in the U.S. Although CCHD newborn screening reduces morbidity and mortality, there remain important opportunities to improve. An expert panel convened for a one-day meeting in September 2018, including subject matter experts and representatives from stakeholder organizations. Presentations on CCHD outcomes, variations in approach to screening, and data and quality improvement helped identify opportunities to improve. The expert panel concluded sufficient evidence exists to recommend modifying the current AAP algorithm by i) requiring an oxygen saturation of at least 95% in both (formerly either) the upper and lower extremities to pass and ii) requiring only one repeat screen instead of two, for cases which neither pass nor fail initially. The panel underscored the importance of improving public health reporting by further specifying the targets of screening and criteria for reporting outcomes (false negative and false positive cases). The panel also highlighted the need to assure sufficient public health funding for CCHD newborn screening and opportunities for education and global implementation. Newborn screening for CCHD using pulse oximetry has led to significant improvements in child health outcomes. However, further important work is required to understand and improve the effectiveness and efficiency of screening.