The American Academy of Pediatrics (AAP) has updated their clinical recommendations for a crucial heart screening protocol for newborn infants. The simple, noninvasive screening using pulse oximetry has been part of the U.S. Recommended Uniform Screening Panel since 2011. Today, it is a required part of newborn screening in all 50 states.

A clinical report containing the updates was published in the Pediatrics January 2025 edition (online December 16, 2024). The report, "Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations," includes endorsement of several new updates for health care providers as well as some other key takeaways from the first 14 years of national screening implementation.

Protocol updates reduce time from screening to intervention

The AAP recommendations refine the already successful protocol to ensure the screening is applied consistently, accurately and efficiently. Changes include:

• A more simplified CCHD screening algorithm that eliminates a second verification re-screen so treatments can start sooner when intervention is urgent.
• Oxygen saturation measurements of 95% or greater in both the right hand and either foot for an infant to pass. Previously 95% or greater oxygen saturation measurements in the right hand or either foot would pass.

A lifesaving unintentional benefit

The report also highlights an important, unintended benefit of pulse-oximetry screening that became evident after long-term implementation: The screening protocol also detects critical noncardiac conditions such as sepsis and pneumonia that benefit from early identification and treatment in vulnerable newborns. In fact, the authors note that for every case of critical congenital heart disease detected, four or five cases of infections or respiratory causes of low oxygen saturation are identified.

Recommendations for the next decade

The clinical report authors also note several recommendations for continued implementation of the screening algorithm.

• Screening with pulse oximetry is best when paired with fetal ultrasounds and newborn examination. It should not be used alone to determine whether an infant has critical congenital heart disease.
• Data collection, data sharing and improved access to care, including electronic data exchanges and stronger collaborations between birth hospitals and public health programs, are critical for these screening protocols to serve as tools to improve outcomes for children born with congenital heart disease.

"The earlier we can detect these conditions, the earlier we can treat these babies during their first days of life," said Gerard R. Martin, M.D., M.A.C.C., F.A.H.A., F.A.A.P., senior author and pediatric cardiologist at Children's National Hospital. "The timely coordination of care saves lives and has proven to be cost-efficient. The routine and uniform use of screening at every medical center is essential to ensure equity. We want all newborns born with critical congenital heart disease to benefit from screening no matter where they were born."

Children's National leads the way

Dr. Martin and colleagues across the country continue work to research and refine the algorithm with a focus on standardizing the application for more uniform results and raising awareness of the need for continued collaboration and cross-institutional data sharing to improve outcomes nationwide.

Since 2009, Dr. Martin and nurses at Children's National have been part of the national cohort of clinicians who advocate for this screening for newborns in every birthing hospital. Findings from long-term implementation studies conducted by Children's National and Holy Cross Health in Maryland have helped further refine the algorithm and establish the scientific evidence for its benefits and effectiveness.

Read the AAP's press release about the updates: AAP updates recommendations on use of pulse oximetry to screen newborns for critical congenital heart disease.

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