Algorithm for newborn pulse oximetry screening for critical congenital heart disease

AAP: American Academy of Pediatrics; CCHD: critical congenital heart disease; FiO2: fraction of inspired oxygen, NICU: neonatal intensive care unit.

* During CCHD screening, the newborn should either have no respiratory support or any respiratory support should have an FiO2 of 0.21 (room air). UpToDate's suggested approach for newborns receiving oxygen therapy is as follows:

• Pulse oximetry monitoring should be performed as clinically indicated for the infant's condition.
• The screening procedure should be deferred until the infant has been weaned off oxygen; for preterm neonates who are cared for in the NICU setting, this may result in screening being performed well beyond the standard 24-hour timeframe.
• If the infant has not been weaned to room air by the time of discharge, then echocardiography is warranted, and pulse oximetry screening is not necessary.

¶ The standard timeframe for performing pulse oximetry screening, as recommended by UpToDate and the AAP, is at age ≥24 hours or as late as possible if the newborn will be discharged before 24 hours. UpToDate's experts stress that screening within the first 24 hours after birth is not as specific as later screening, because hypoxemia commonly occurs during the transition from intrauterine to extrauterine life.