AAP Backs Simpler Test for Critical Congenital Heart Disease

The American Academy of Pediatrics (AAP) has endorsed a simplified screening algorithm for critical congenital heart disease (CCHD) and more uniform reporting of data in updates included in its new clinical report.

The clinical report, published in the January 2src25 issue of Pediatrics and online on December 16, addresses key developments since pulse oximetry screening was added to the US Recommended Uniform Screening Panel in 2src11. Since that time, CCHD screening has decreased infant mortality, has been found to be cost-effective and has saved resources, the authors point out.

“The use of a simple bedside test, pulse oximetry, estimates the amount of oxygen in the baby’s blood and has become a lifesaver,” Matthew E. Oster, MD, MPH, a pediatric cardiologist at Children’s Healthcare of Atlanta and lead author of the report, said in a press release. “This clinical report builds on the landmark achievements the medical field has accomplished in screening infants for heart defects.”

Two Important Changes in Algorithm

Guidance in the clinical report includes two important changes in the algorithm: First, the lower limit of acceptable oxygen saturation should be at least 95% in both the pre- and postductal measurements. Authors explain that studies have shown that allowing the saturation to be 95% in either the right arm or a lower extremity can be confusing and lead to misinterpretation.

Second, there should be only one retest, instead of two, for indeterminate results, the report advises. The rationale is shorter time to recognition of CCHD and potentially increased sensitivity without a clinically significant effect on retesting rates,” the authors wrote. The previous two-retest guidance was aimed at decreasing false-positives, but the fear of an increased burden on the healthcare system never materialized, the authors wrote.

Report authors also caution pediatricians not to rely solely on screening with pulse oximetry to determine whether an infant has CCHD and to be aware that CCHD may still be present in a child who has “passed” CCHD screening.

Uniform Data Collection Needed

The authors point out that CCHD screening is a state-implemented public health program, and thus there are notable differences in data collection and quality improvement efforts by state.

“The lack of standardized data collection efforts hinders the ability to truly assess the effect of CCHD screening on a national level,” the authors wrote. “The national adoption of a previously identified uniform dataset for CCHD screening surveillance would overcome some of these obstacles.”

Monique Gardner, MD, attending physician with the Division of Cardiac Critical Care Medicine at Children’s Hospital of Philadelphia, Philadelphia, said that the recommendations build on the guidelines published by the AAP more than 1src years ago for screening of CCHD.

“While that implementation has resulted in universal adoption of CCHD screening,” she says “there still remains practice variation in exactly how pulse oximetry is used. These updated recommendations offer more explicit guidelines for how to go about pulse oximetry.”

She added that this guideline will simplify and reduce variation in practice. “This guideline calls for more improved data collection, which can foster more understanding of the impact that early detection of CCHD has on improving outcomes. The education included within the guidelines for healthcare providers is also incredibly helpful and should be shared across multiple disciplines.”

About eight in 1srcsrcsrc infants have CHD, while life-threatening CCHD, affects about two to four of every 1srcsrcsrc births, the authors note.

The report was written by the AAP Section on Cardiology and Cardiac Surgery, Section on Hospital Medicine, and the Committee on Fetus and Newborn.

The authors and Gardner reported no relevant financial relationships. 

Marcia Frellick is a freelance journalist based in Chicago. She has written for the Chicago Tribune, Science News, Northwestern magazine, Oncology News Central, MedCentral, and Nurse.com and was an editor at the Chicago Sun-Times, The Cincinnati Enquirer, and the St. Cloud (Minn.) T