Dr. Glen Green

By Dr. Glen Green

Before newborns leave the hospital, they are screened for several medical conditions, including Critical Congenital Heart Disease.

Critical Congenital Heart Disease (CCHD) is a group of heart defects that can cause serious, life-threatening symptoms in newborns. In the United States, about 4,800 (or 11.6 per 10,000) babies born each year have one of seven critical congenital heart defects.

Flaws in the structure of the heart and blood vessels are a leading cause of death in newborns and may not be apparent in the first few day of life. Some babies born with a heart defect can appear healthy at first and before the screening procedure was started could be sent home with their families before their heart defect is detected.

When the condition is found early and babies have corrective surgery quickly, the rate of death from CCHD can decrease. The test is intended to detect CCHD, not minor heart defects such as heart murmurs.

The U.S. Health and Human Services and the American Academy of Pediatrics recommend performing pulse oximetry screening on all newborns at 24 to 48 hours of age to enhance detection of Critical Congenital Heart Disease (CCHD). Pulse oximetry is a painless and easy method to detect oxygen levels in the blood stream. Each newborn infant will have two pulse oximeter readings one of the right hand and one foot.

Normal values for newborn pulse oximetry readings  are  ≥95% in either extremity with a ≤3% absolute difference between the upper and lower extremityin order to pass the test. In order to reduce false-positive results (~ 1.4 per 1,000), up to two repeated screenings may be performed in those cases in which the initial screening result was positive. Infants with saturations <90% receive immediate evaluation and will require a diagnostic echocardiogram by a pediatric cardiologist to exclude CCHD.  Other reasons for low oxygen saturation by pulse oximetry such as infection and respiratory disease should also be excluded. The baby’s physician will discuss any positive screening and the results of any additional evaluation.

In the US, about 4,800 (or 11.6 per 10,000) babies born each year have one of seven critical congenital heart defects (CCHDs) Ask your Sentara physician for more information about Critical Congenital Heart Disease and the screening test.


Congenital heart defects (CHDs) account for 24% of infant deaths due to birth defects.

Critical congenital heart defects (CCHDs) make up about 17-31% of all CHDs.

CCHDs require some type of intervention―often involving surgery―soon after birth.


Adapted from Reller, MD, Strickland, MJ, Riehle-Colarusso, TJ, Mahle, WT, Correa, A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153:807-813.

Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National Vital Statistics Reports. 2010;58(19). Hyattsville, MD National Center for Health Statistics.

Adapted from Knapp, AA, Metterville, DR, Kemper, AR, Prosser, L, Perrin, JM. 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.