The American Academy of Pediatrics released new recommendations for critical congenital heart disease screening, marking the first major update to the screening protocol since 2011.
The clinical report, published in Pediatrics, introduced a simplified algorithm and new guidance for data collection. The revised guidelines featured two significant changes to the screening algorithm. First, newborns must achieve oxygen saturation levels of ≥ 95% in both pre- and postductal measurements, replacing the previous requirement of acceptable saturation in either measurement. Second, the protocol reduced repeat screening from two attempts to one for indeterminate results.
Data demonstrated the screening program's impact on infant mortality. States with mandatory screening policies saw a 33% decrease in early infant mortality from critical congenital heart disease (CCHD) compared with states without such policies. By July 2018, all U.S. states and territories had adopted CCHD screening.
Cost analysis revealed screening costs of $14.19 per newborn in 2011 dollars, with costs decreasing through reusable sensor use. The procedure averaged 9.1 minutes per newborn, with a cost of $12,000 per life-year gained. Studies found no increase in health care resource utilization; some regions reported decreased use of neonatal echocardiography.
The screening program's sensitivity ranged from 50% to 76% overall, with detection rates for specific conditions like coarctation of the aorta as low as 21%. One successful electronic health record–driven protocol achieved 98.9% screening compliance.
Research identified disparities in prenatal detection rates, which remained under 60% in many U.S. regions. Studies found lower detection rates associated with poverty, rural residence, and public insurance coverage. The guidelines addressed special circumstances, including altitude considerations above 6,800 ft where screening accuracy required modification.
The program detected conditions beyond CCHD. Infants who failed screening more frequently presented with non-CCHD conditions, including sepsis, pneumonia, and persistent pulmonary hypertension. Early identification of these conditions helped prevent deterioration in newborn nurseries.
Implementation varied across states. New Jersey required ≥ 95% saturation in both pre- and postductal measurements, whereas Tennessee initiated screening with lower extremity measurement at a ≥ 97% threshold.
The American Academy of Pediatrics recommended state programs adopt a standardized minimum dataset to improve surveillance. The report called for enhanced education regarding screening limitations and emphasized the importance of data collection for ongoing quality improvement.
The updated guidelines reflected more than a decade of implementation experience across all U.S. states and territories, incorporating evidence from multiple studies demonstrating the program's cost-effectiveness and public health impact.
