AAP updates recommendations for screening newborns for congenital heart disease
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Key takeaways:
- To pass the screening, infants should have an oxygen saturation of at least 95% in both the right arm and right foot.
- Providers need to perform only one retest for indeterminate results instead of two.
The AAP published updated recommendations for screening newborns for critical congenital heart disease with a new algorithm it said could catch more infants than the previous one.
Screening for critical congenital heart disease (CCHD) has been part of the United States’ recommended uniform screening panel for newborns since 2011. At that time, the AAP endorsed an algorithm using pulse oximetry.
Since then, studies have shown that early infant deaths related to CCHD fell 33%, according to Matt E. Oster, MD, MPH, FAAP, a pediatric cardiologist and director of the Children’s Program to Evaluate and Advance Cardiovascular Health at Children’s Healthcare of Atlanta, and colleagues.
In December 2024, the AAP released an updated clinical report with a new algorithm and recommendations about collecting data.
“The biggest updates to the recommendations are the two changes to the algorithm,” Oster told Healio.
The new algorithm, which was published in 2020, requires infants to have an oxygen saturation of at least 95% in both the right arm and right foot instead of one or the other. Additionally, providers need to perform only one retest for indeterminate results rather than two.
“The new algorithm will still catch all babies who would have failed the old algorithm, and it may catch a few more,” Oster said. “It will also catch more false positives, but those are typically children who may have other important causes of hypoxemia that need to be addressed.
The updated clinical report provided a clarification that infants should be in room air during the screening. If they need respiratory support, it should be an FiO2 of 21%, the authors specified.
They also noted that the sensitivity of pulse oximetry ranges from 50% to 76% for CCHD screening.
“Like before, there will still be false negatives, so pediatricians should not rely solely on pulse oximetry screening in order to rule out critical congenital heart disease,” Oster said.
The AAP’s new report encourages state public health programs to adopt a method to collect data about CCHD screening to share across states and hospital systems.
“Such data could prove useful both by ensuring quality in the implementation of CCHD screening and by informing future research to improve the sensitivity and specificity of CCHD screening,” Oster and colleagues wrote.
References:
- Mahle WT, et al. Pediatrics. 2011;doi:10.1542/peds.2011-3211.
- Martin GR, et al. Pediatrics. 2020;doi:10.1542/peds.2019-1650.
- Oster ME, et al. Pediatrics. 2024;doi:10.1542/peds.2024-069667.
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