Written by Kimiko Dunbar
Spoon Feed
The AAP has updated congenital heart disease screening guidelines, changing the lower limit of saturation to ≥ 95% in both pre- and post-ductal measurements and allowing for just one screening repeat after failure.
Did New Jersey have it right all along?
Critical congenital heart disease (CCHD) screening was first recommended in 2011 and was implemented by all states by 2018, though a few have made modifications. For example, in New Jersey, instead of requiring the right hand OR the lower extremity to have a saturation of ≥95%, you must have both be ≥95% to pass. In Tennessee, you can pass if your lower extremity is ≥97% without checking the right hand at all. This clinical report updates guidelines on newborn screening for CCHD, refines screening protocols, and emphasizes data collection.
Major clinical updates are as follows:
- The lower limit of O2 saturation is now ≥95% in both pre- and post-ductal measurements, to avoid confusion and increase sensitivity.
- If an infant fails, only repeat once.
- Wait until off supplemental oxygen to avoid false negative screening.
States should collect data to maintain a database. Education is needed on the limitations of screening, as not all CHD is detected and failures may also be from respiratory disease, sepsis, etc. Streamlined order sets can facilitate screening and work-up, when necessary.
How will this change my practice?
In most settings, this seems like a good thing. Simplifying and standardizing a minimum saturation in both pre- and post-ductal limbs provides much-needed clarity on what constitutes a pass. Personally, as a provider who works at altitude, these updates have stirred up a lot of discussion in my practice. I’m worried about how these recommendations should be modified to avoid overuse of echo and other resources (the guidelines address this, but research is limited on how to “correct” for altitude). Overall, we’ll need to keep a close eye on utilization of resources with these changes.
Source
Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations: Clinical Report. Pediatrics. 2025 Jan 1;155(1):e2024069667. doi: 10.1542/peds.2024-069667. PMID: 39679594
