The Road to Universal Pulse-Oximetry Screening: Are We There Yet?

Abstract

Congenital heart disease is the most common birth defect and represents nearly 40% of all deaths caused by congenital anomalies.1 Critical congenital heart disease (CCHD), which encompasses the more severe forms, is present in 2.5 to 3 in 1000 live births.2 In general, prenatal ultrasound or physical examination alone can easily miss newborns with CCHD.3,4 Failure to diagnose CCHD early in life can result in high morbidity and mortality rates, because symptoms frequently present after closing of the pulmonary ductus arteriosus, after nursery discharge. Pulse-oximetry screening is a low-cost, painless, noninvasive test that increases the ability to identify newborns with CCHD before they clinically decompensate.5,–,8 In 2009 the American Heart Association and American Academy of Pediatrics published a scientific statement regarding the role of pulse oximetry in examining newborns for CCHD.9 Despite presenting strong support for this method, they stopped shy of recommending universal screening and called for further studies on implementation. In September 2010, the US Department of Health and Human Services (HHS) Secretary's Advisory Committee on Heritable Disorders in Newborns and Children recommended that CCHD be added to the uniform screening panel. However, … Address correspondence to Sandra Cuzzi, MD, Division of Hospitalist Medicine, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010. E-mail: scuzzi{at}childrensnational.org