Title: A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry | American Academy of Pediatrics
Headings: A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry
A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry
Abstract
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What’s Known on This Subject:
What This Study Adds:
Methods
Identifying True-Positives, False-Positives, True-Negatives, and False-Negatives
Simulation Study
Statistics
Results
Discussion
Strengths
Limitations
Conclusions
Footnotes
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Content: 1–3 Among infants with CHD, ∼25% have lesions considered to be critical congenital heart disease (CCHD), requiring surgical or catheterization intervention within the first year of life. 1 Although the 1-year survival rate for infants with CCHD has improved over the decades, 4 it remains a leading cause of infant morbidity and mortality. 5 To aid in the early detection of CCHD, screening for CCHD by using pulse oximetry was added to the US Recommended Uniform Screening Panel in 2011 and has been endorsed by multiple professional societies, including the American Academy of Pediatrics (AAP), the American Heart Association, and the American College of Cardiology, to improve early identification of infants with CCHD. 6,7 Recently, CCHD screening has been shown to decrease infant mortality from CCHD in states with mandatory screening policies. 8 CCHD pulse oximetry screening was added to the Georgia newborn screening panel in 2015, 9 although many hospitals in Georgia began using CCHD pulse oximetry screening as early as 2012. 10
Current CCHD screening recommendations involve the use of pulse oximetry to detect levels of hypoxemia in the newborn infant. On the basis of the pulse oximetry values, an algorithm is used to determine if a child has passed or failed screening; however, there is no single algorithm that has been proven to be superior. 6,11 In most states in the United States, screening is performed by using the algorithm endorsed by the AAP ( Fig 1 ), 12 although other states such as New Jersey 13 and Tennessee 14 have adopted modifications of that algorithm. The AAP algorithm is based off of previous work performed in Sweden.