- Information for Hospitals
- Provider Training for CCHD Screening
- Data Reporting for CCHD
- Out-of-Hospital Births
- State Screening Requirement
- Information for Families
Newborn screening for CCHD can identify newborns with these conditions before signs or symptoms are evident and before the newborns are discharged from the birth hospital. Read below to learn more about the screening algorithm, tools, and resources for critical CHD screening.
CCHD Screening Methods
Current published recommendations focus on screening newborns in the well-baby nursery and in intermediate care nurseries or other units in which discharge from the hospital is common during a newborn’s first week of life. Timing the screening around the time of the newborn hearing screening can help improve efficiency. A pulse oximeter is used to measure the percentage of hemoglobin in the blood that is saturated with oxygen.
CCHD Screening Protocol
A screen is considered failed if
- Any oxygen saturation measure is <90% (in the initial screen or in repeat screens),
- Oxygen saturation is <95% in the right hand and foot on three measures, each separated by one hour, or
- A >3% absolute difference exists in oxygen saturation between the right hand and foot on three measures, each separated by one hour.
Any infant who fails the screen should have an evaluation for causes of hypoxemia. In most cases this will include an echocardiogram, but if a reversible cause of hypoxemia is identified and appropriately treated, an echocardiogram may not be necessary. The infant’s pediatrician should be notified immediately and the infant might need to be seen by a cardiologist.
Any screening with an oxygen saturation measure that is ≥95% in the right hand or foot with a ≤3% absolute difference between the right hand or foot is considered a passed screen and screening would end. Pulse oximetry screening does not detect all critical CHDs, so it is possible for a baby with a passing screening result to still have a critical CHD or other CHD.
Ways to Reduce False Positive Screens
- Screen the newborn while he or she is alert
- Screen the newborn when he or she is at least 24 hours old
Other Tools or Resources
American Academy of Pediatrics: Critical Congenital Heart Defect (CCHD) Screening Resource for Primary Care Providers This online resource was developed by doctors for doctors, to help primary care providers navigate the implementation process and provide effective, long-term medical homes for babies with critical CHDs. American Academy of Pediatrics: Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease. [Read article ] Children’s National Medical Center’s Congenital Heart Disease Screening Program has created videos about critical CHD screening for parents and healthcare professionals. They also have a toolkit for implementing critical CHD screening. Congenital Heart Public Health Consortium (CHPHC) The CHPHC is a group of organizations uniting resources and efforts in public health activities to prevent congenital heart defects and improve outcomes for affected children and adults. Their website provides resources for families and providers on heart defects and screening. Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson GD, Glidewell J, Grosse SD, Lloyd-Puryear M, Howell RR. Strategies for implementing screening for critical congenital heart disease. Pediatrics. 2011; 128:e1-8. [Read article ] Evidence review: Critical congenital cyanotic heart disease, Final Draft, September 3, 2010. Prepared for the Maternal and Child Health Bureau, Health Resources and Services Administration. [Read article ] Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH, 3rd, Grosse, SD. Role of pulse oximetry in examining newborns for congenital heart disease: A scientific statement from the AHA and AAP. Pediatrics. 2009;124:823-36. [Read article] NewSTEPS This webpage on critical congenital heart defects provides a central location for resources related to these conditions, including webinars, legislative updates, and news. NIH/NLM Newborn Screening Coding and Terminology Guide This guide provides the data standards for electronic reporting of critical congenital heart defects. Pulse Ox Tool This web application and mobile app are provided as a free service by Children’s Healthcare of Atlanta to aid healthcare professionals in screening for critical congenital heart defects. Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet. 2012; 379:2459-64. [Read article *This webpage is reproduced from the CDC webpage on CCHD Information for Providers.
Additional Training and Information on CCHD Screening:
ECHO training thru Wisconsin SHINE Project
The Sonographer Education portion is designed to assist cardiac sonographers in performing the initial neonatal echocardiogram as part of a comprehensive evaluation for hypoxia. Sonographers performing these echocardiograms may not regularly image pediatric patients and may have limited familiarity with the differences between congenital echocardiography and adult echocardiography. The program reviews “The Terrible Ten” echo findings of critical congenital heart disease and helps the sonographer generate a differential based on those findings. The program also discusses common forms of critical congenital heart disease in more detail.
The program is organized into an introduction and overview portion, detailed discussion of the “Terrible Ten” findings, and individual sections on each form of critical congenital heart disease.
American Academy of Pediatrics
- Strategies for Implementing Screening for Critical Congenital Heart Disease. Alex R Kemper, MD et al. Volume 128, Number 5, November, 2011
- Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: a Scientific Statement from AHA and AAP.William T Mahle et al. Volume 124, Number 2, August, 2009
Centers for Disease Control and Prevention
The Heart Association
American College of Cardiology
FDA Approved Pulse Oximetry Devices
Under the amended rules, data on CCHD screening must be reported “in a manner prescribed by the Department”. Click here for a printable copy of the data input instructions. Click here for a sample consent/waiver form for CCHD and bloodspot screening
Some babies in Wyoming are born in settings outside of a birthing facility. This may include births that take place outside of a hospital. As of December 1, 2017, screening for CCHD using pulse oximetry is required for all babies in Wyoming, regardless of location of delivery. This recommendation was recently reinforced by the American Academy of Pediatrics in the 2013 Policy Statement on Home Births.
AAP Recommends Pulse Oximetry Screening Be Performed After Planned Home Births and Hospital Births
In May 2013, the American Academy of Pediatrics released a policy statement “Planned Home Birth” with recommendations for the care of infants born at home. This new policy statement is based on the premise that all babies, regardless of the circumstances of their birth, deserve a high quality standard of care. Included in this policy statement is the specific recommendation that “Screening for congenital heart disease should be performed by using oxygen saturation testing as recommended by the AAP.” View the Entire Policy Statement If you are a midwife needing assistance with implementing CCHD Screening in your practice, or you need more information on where to send your clients for CCHD screening, please contact Carleigh Soule at (307) 777-6297 or firstname.lastname@example.org. Click here for a sample consent/waiver form for CCHD and bloodspot screening.
Pulse Oximetry Screening for Critical Congenital Heart Disease (CCHD) – December 1, 2017
Screening for CCHD by Pulse Oximetry became mandatory for all Wyoming Newborns on December 1, 2017. This means that every baby born in Wyoming will be screened for CCHD prior to discharge. Babies born out of hospital are also required to be screened.
Critical Congenital Heart Disease (CCHD) affects the lives and families of approximately 10,000 babies born in the United States every year. While many of these babies will be identified by prenatal ultrasound and newborn exam, some of these babies will appear perfectly healthy in the newborn period. To prevent serious morbidity and mortality resulting from missed or delayed diagnosis of CCHD, in 2011 the U.S. Secretary of Health and Human Services recommended that all newborns be screened for CCHD using pulse oximetry.
What to Expect: After your baby is born, your health care team will do some exams and screenings. One of the newest screens is for serious heart problems that your baby may have at birth. Health care providers call these problems “Critical Congenital Heart Disease (CCHD).” This screen for serious heart problems is called pulse oximetry. This screen:
- measures oxygen in your baby’s blood
- is easy and painless
- is usually done when your baby is between 24 to 48 hours old. If your child is on supplemental oxygen in the first days after birth, the pulse oximetry testing may be postponed
To do this screen, a nurse will put a small sensor, called a probe, on your baby’s right hand and on your baby’s foot. The probe measures the oxygen in your baby’s blood. What is critical congenital heart disease (CCHD)? CCHD is a problem with the structure of the heart that is present at birth. CCHD can be life threatening if not found quickly. How common is CCHD? In the United States, about 7,200 (or 18 per 10,000) babies born every year have CCHD (Source: Centers for Disease Control and Prevention). What are the causes of CCHD? The causes of CCHD among most babies are not known. Some babies have heart defects because of changes in their genes or chromosomes. Another possible cause is a combination of genes and certain risk factors; such as infection, use of drugs or certain medications during pregnancy. Why is pulse oximetry used to screen for CCHD? Some babies with CCHD can look and act healthy at first. Pulse oximetry screening, sometimes called “pulse ox” screening, is a simple and painless way to measure the oxygen level in your baby’s blood. This can help identify babies that may have CCHD. Screening for CCHD is recommended and supported by: U. S. Department of Health and Human Services, the American Heart Association, the American College of Cardiology, the American Academy of Pediatrics and the March of Dimes. How is pulse oximetry screening performed? A sticky strip with a red sensor light will be wrapped around your baby’s right hand, and then around one of your baby’s feet. The screening should not be performed while your baby is eating, sleeping or crying as it could lead to inaccurate results. Screening should be completed at 24 hours of life or before discharge from a birth facility, but no later than 48 hours of life. What is a normal pulse oximetry reading? A normal reading for healthy babies is 95% or higher with a difference of three percent or less between the hand and foot. If your baby is known to have a heart or lung problem, the range could be different. Your nurse or doctor can discuss this with you. What happens if my baby’s screening is out of range? If your baby’s screening is not within the normal range, he or she may need additional testing. Your baby may undergo an ultrasound of the heart, called an echocardiogram, to check for heart defects. The hospital should provide you with the results and notify you if your baby needs additional care.
Baby’s First Test
- Baby’s First Test – CCHD
March of Dimes (MoD)
- March of Dimes – Congenital Heart Defects and CCHD
- March of Dimes – CCHD Fact Sheet
- March of Dimes – CCHD Issue Brief
Videos for Parents
- Newborn Screening for Heart Defects (CCHD) using Pulse Oximetry
- Spanish: Heart Smart: CCHD Screening for Parents – Children’s National Medical Center
- The Heart of the Matter