Critical Congenital Heart Disease Screening

Office of Children With Special Health Care Needs

Information for midwives

Some babies are born at home, delivered by a midwife or delivered in a birthing center. Screening for CCHD using pulse oximetry is required for all babies born in Utah, regardless of location of delivery.

The greatest challenges to screening newborns born outside of birthing facilities are access to screening equipment, timing the screen appropriately, and ensuring timely follow up when needed.

CCHD Screening: Basic Facts

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Equipment Overview

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Reporting the CCHD Screening Result

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CCHD Screening: Basic Facts

Utah uses the CCHD Screening Protocol endorsed by the US Secretary of Health and Human Services and the American Academy of Pediatrics. Pulse oximetry screening does not replace a complete history and physical exam.

Pulse oximetry has its lowest false positive rate if performed 24 hours after birth or later.

“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 newborn 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.

Equipment Overview

A variety of pulse oximeters are available for use in newborns. Important features to look for when choosing a pulse oximeter are:

FDA approval for use in newborns
Screening should be completed with motion tolerant pulse oximeters that report functional oxygen saturation.
Manufacturer-recommended pulse oximeter-probe combinations should be used.
Pulse oximeters can be used with either disposable or reusable probes
- Both disposable and reusable probes with a disposable foam wrap are available.
- Probes are available in two sizes: neonatal probes for babies weighing less than 3 kilograms, and infant probes for babies weighing 3 kilograms or more.

Reporting the CCHD Screening Result

Reporting of CCHD Screening is covered by Birth Defect Reporting Rule R398-5 opens in a new tab.The outcome of the CCHD Screen (Pass, Fail or Not Screened) is recorded on the birth record.

Results of the newborn CCHD screening should be communicated to the newborn’s primary care provider and an appropriate mechanism should be established to ensure that the results of the pulse oximetry screening are recorded in the chart and are available as needed.

CCHD Screening SpO2 Results can be reported in any of the following ways through email email cchd@utah.gov or fax (801) 323-1578:

CCHD Reporting Form (Single Birth)opens in a new tab
CCHD Reporting Form (Multiple Births)opens in a new tab
Champion Reporting Form opens in a new tab
Electronically via the Early Hearing, Detection and Intervention Database "HiTrack" (contact the CCHD Screening Program for more information).

Newborns and children diagnosed with CCHD are reported to the Utah Birth Defect Network. All newborns diagnosed with CCHD, including those diagnosed prenatally, on newborn physical exam, through CCHD Screening, and later clinical presentation (up to two years of age) are included in this registry.

Results of the CCHD 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 newborn 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 newborn 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

All newborns who fail the screen must be examined by a health care provider and may need an echocardiogram to evaluate for CCHD. Echocardiograms are performed on newborns at a number of hospitals in Utah.