Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit

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OBJECTIVE:To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening.STUDY DESIGN:Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n = 4556 infants).RESULTS:Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ≥ 2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at < 28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%).CONCLUSION:Given the majority of NICU infants were ≥ 2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.

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