Critical Congenital Heart Disease Screening

Office of Children with Special Health Care Needs

CCHD Screening by Pulse Oximetry Facts

If you have questions that are not answered here, or if you would like more information about this screen, please ask your medical care provider or contact the Utah CCHD Screening Program either by email email cchd@utah.gov or by phone (866) 818-7096.

Who should be screened?

All babies born in Utah should be screened for Critical Congenital Heart Disease, including babies admitted to the NICU and babies born outside the hospital.

What is Pulse Oximetry Screening?

Pulse oximetry is a painless and non-invasive way to measure the amount of oxygen in blood. Light is passed through the skin and measured by a sensor to determine the percent oxygen saturation. Babies with an abnormally low oxygen saturation in their blood will need further evaluation for critical congenital heart disease or other problems which can cause low oxygen saturations.

When should babies be screened?

Many normal newborns have oxygen saturations lower than 95-100% in the first hours of life as their bodies adjust to life outside the womb. By 24 hours of life, this transition period should be done and oxygen saturations should be 95% or greater. Pulse oximetry screening should be done after 24 hours.

Normal Heart Connections BEFORE Birth

Normal Heart Connections Before Birth Before birth, the arteries giving blood to the lungs (Pulmonary Artery) and to the body (Aorta) are connected by a large blood vessel called ductus arteriosus. This normal part of the body is designed to close in the first few days after a baby is born.

In many forms of critical congenital heart disease, the normal parts of the heart use the ductus arteriosus to help out the abnormal parts of the heart. These babies can appear to be healthy while this connection is open and one side of the heart can help the other. However, when the ductus arteriosus closes, the baby’s heart problem can show itself very quickly.

Normal Heart Connections AFTER Birth

Normal Heart Connections After Birth

In people with a normal heart, blood from the body which is low in oxygen (pictured here in blue) comes to the right side of the heart and is pumped to the lungs. Blood coming from the lungs containing high concentrations of oxygen (pictured here in red) comes back to the left side of the heart and is pumped to the body. In most people, the blue and red blood doesn’t ever mix. In babies with CCHD, there is mixing of the low and high oxygen blood somewhere in the heart or blood vessels (pictured in these diagrams in maroon)

Some babies require supplemental oxygen after they are born. In this case, screening should be delayed until the baby no longer needs extra oxygen. If a baby is going home on supplemental oxygen, the health care provider will evaluate the newborn prior to discharge and the baby may have an echocardiogram in lieu of screening by pulse oximetry.

Where should babies be screened?

A pulse oximetry probe will measure the oxygen saturation in the right hand and in either of the feet. Measuring in these two places gives a more accurate picture of the function of the heart.

How are babies screened?

“Two Sites, Three Strikes” is the easiest way to understand CCHD screening:

Two Sites	A pulse oximetry probe will measure the oxygen saturation in the right hand and the right or left foot. Measuring in these two places gives a more accurate picture of the function of the heart.
Three Strikes	A baby has three chances to pass pulse oximetry screening unless they are found to have very low oxygen saturation less than 90% (<90%) in the hand or the foot at any point in the screening process.

How does a baby pass or fail the screen?

Pass	Pulse oximetry reading greater than 95% (>95%) in either hand or foot and difference between hand and foot are less than or equal to 3% (<=3%) is an immediate pass and no further screening is needed.
Fail	Pulse oximetry reading less than 90% (<90%) at either site at any time during the screening is an immediate fail and the baby will require further evaluation.
Repeat	If the pulse oximetry reading is between 90-94% in right hand AND foot or if there is greater than 3% difference between two sites, the screen will be repeated one hour later. At the repeat screen the baby can pass, fail, or require one more repeat screen an hour later. After the third screen the baby will either pass or fail. Pulse oximetry between 90-94% in the right hand AND foot or greater than 3% (>3%) difference between two sites on the third screen is considered a fail.

Failed Screen

Infants fail pulse oximetry screening when the oxygen saturation of their blood is lower than expected. Low levels of oxygen in the blood can be caused by many problems including critical congenital heart disease (CCHD). All babies who fail the screen must be examined by a health care provider and may need an echocardiogram to evaluate for CCHD.

An echocardiogram, also known as a cardiac ultrasound, is one of the most common tests used to diagnose congenital heart disease. Echocardiograms use ultrasound to create pictures of the heart and can also measure blood flow using Doppler ultrasound technology. This allows an accurate assessment of the structure and function of the heart.

A technician who specializes in performing pediatric echocardiograms will use an ultrasound probe to take pictures of your baby’s heart. This test is very similar to the ultrasound of your baby that you may have had during pregnancy. Like the ultrasound, echocardiograms are non-invasive and will not cause your baby any pain or discomfort. There are no known risks or side effects of echocardiograms.

Echocardiograms are done on newborns at a number of hospitals in Utah. If your baby is born in a location where echocardiograms are not available, your baby may be referred to a hospital where this test can be done. Once the echocardiogram has been done, a pediatric cardiologist will interpret the results. If there is not a pediatric cardiologist at the hospital where the echocardiogram is done, the results will be sent digitally to a hospital with a pediatric cardiologist.

Regardless of where the echocardiogram is done and interpreted, your baby’s health care provider and the pediatric cardiologist will be in close communication about the results of this test.