Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations: Clinical Report

Process Improvement for Family-Centered Congenital Heart Disease Deliveries

BACKGROUND

Perinatal care coordination for the birth of infants with prenatally detected ductal-dependent congenital heart disease (DDCHD) has historically been limited by the siloing of cardiologists and neonatologists and by singular focus on risk reduction. The aim of this study was to increase time for parent-infant bonding and decrease overutilization of medical resources by developing and implementing a standardized delivery stratification system for infants with CHD.

METHODS/INTERVENTIONS

Over the course of multiple Plan-Do-Study-Act cycles from 2015 to 2023, we identified risk factors for respiratory intervention immediately after birth among infants with DDCHD, drivers of unnecessary intervention and resource utilization, and barriers to allowing time for parent-infant bonding. This led to development of standardized documentation and communication and a color-coded risk-stratification system that allowed for the identification of a low-risk cohort of infants eligible for demedicalized, immediate postnatal care despite the presence of critical CHD.

RESULTS

Through a series of process improvements and implementation of a delivery risk-stratification system, we were able to maintain neonatal safety while decreasing use of the operating room for vaginal deliveries from 100% to 10% and increasing the rate of time for parent-infant bonding in the first hours of life from 62% to 91%.

CONCLUSION

Multidisciplinary collaboration and iterative quality improvement work supported the safe improvement in allowing parent-infant bonding after birth for infants with critical CHD with a decrease in unnecessary respiratory intervention and obstetric resource utilization. Our findings support adoption of a collaborative risk-stratification approach for other congenital anomaly cohorts.

Prospective Evaluation of Pulse Oximetry Screening for Critical Congenital Heart Disease in a Jordanian Tertiary Hospital: High Incidence and Early Detection Challenges

BACKGROUND/OBJECTIVES

Critical congenital heart disease (CCHD) is among the major causes of global neonatal morbidity and mortality. While the incidence of CCHD appears to vary across populations, much of this variation may stem from differences in detection and reporting capabilities rather than true prevalence. In Jordan, recent data revealed a congenital cardiac disease incidence of 17.8/1000 live births, much higher than international averages. Diagnosis is largely dependent upon echocardiography, which is difficult to obtain in low-resource settings where prenatal screening modalities are limited. Screening for CCHD with pulse oximetry offers a potential method to identify patients earlier and contribute to improved outcomes.

METHODS

This prospective cohort study evaluated 20,482 neonates screened using pulse oximetry at Al-Bashir Hospital between January 2022 and May 2024. Demographic data, pulse oximetry measurements, and echocardiogram findings were collected during the screening process after obtaining ethical approval from the Jordanian Ministry of Health.

RESULTS

Pulse oximetry screening identified 752 neonates (3.7%) requiring further evaluation by echocardiography. An abnormality was detected in 240 neonates (31.9%), which included cardiac anomalies and pulmonary hypertension. Screening led to the identification of 138 infants with CCHD, including 80 with a previously unknown diagnosis, and an additional 247 infants with conditions requiring increased monitoring or treatment. Among those with CCHD, hypoplastic left heart syndrome and Tetralogy of Fallot were the most common conditions, 3.1%, and 2.4%, respectively. The overall false positive rate was 1.8% and was higher among those screened at less than 24 h of life compared to those screened at or after 24 h of life (2.3% [95%CI 2.1-2.6] vs. 0.8% [95%CI 0.6-1.0], p < 0.001).

CONCLUSIONS

Pulse oximetry screening successfully led to the early detection of CCHD among Jordanian neonates. There was a high prevalence of CCHD compared to other reported cohorts. This highlights the importance of implementing national screening protocols to improve early diagnosis and intervention. Future studies will inform the feasibility and cost-effectiveness of national implementation in this setting.