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Table 2 Summary of existing recommendations

From: Newborn pulse oximetry screening for critical congenital heart defects

Source Ref Date General recommendations for newborn pulse oximetry screening for CCHDs
AEP [6] 2018 “There is sufficient evidence to recommend neonatal screening by pulse oximetry in the first hours post birth, in addition to prenatal ultrasound and the physical examination.” (Level of evidence A)
“The timing of screening affects its sensitivity, with a higher sensitivity the earlier it is performed.” (Level of evidence A)
“Early screening, within 24h of birth, reduces the risk of onset with severe or very severe symptoms in CCHD at the expense of a greater number of false positives, although most of the latter are indicative of other disorders that may also require observation, diagnosis and treatment, so early screening is preferable to late screening (>24 h). Very early screening (<12 h) may result in an excessive number of false positives, an issue that needs to be weighed at the local level. In case of very early discharge, screening should be performed before discharge, regardless of timing. It is recommended that the screen be performed between 6 and 24 h post birth.” (Level of evidence B)
CDC [4] 2018 The CDC recommends screening of all newborns in well-baby nursery at ≥24 hours of age or shortly before discharge if <24 hours of age, with a subsequent algorithm according to findings (reported by Kemper et al. [11]). In addition, it is recommended that ‘Pulse oximetry screening should not replace taking a complete family health history and pregnancy history or completing a physical examination, which sometimes can detect a critical CHD before the development of low levels of oxygen (hypoxemia) in the blood.’
NICE   2015 “heart; check position, heart rate, rhythm and sounds, murmurs and femoral pulse volume”
AAP [3, 10] 2019 • “All newborns at risk for undetected CCHD should be screened. In other words, the only babies who do not need to be screened are those who are already known to have CCHD, such as those identified by prenatal ultrasound or who have already had an echocardiogram.”
• “Screening should begin after 24 hours of age or shortly before discharge if the baby is less than 24 hours of age. Waiting until 24 hours of life will decrease the false-positive results.”
• “The screening should occur in the right hand and either foot. If using only one pulse oximeter, test one right after the other.”
• “CCHD screening should be conducted by individuals who have pulse-oximetry testing within their scope of practice, who are trained in the use of pulse oximetry and the CCHD algorithm, and who regularly use pulse oximetry for other purposes.”
• “In the event of a positive screening result, CCHD needs to be excluded with a diagnostic echocardiogram. Infectious and pulmonary causes of hypoxemia should also be excluded.”
RCPCH [5] 2019 “Until the result of this study [using PO in 15 NHS Trusts in England] are available, it [PO] cannot be recommended as a routine addition to the existing newborn physical examination tests within 72 hours of birth.”
UK NSC [14] 2014 • “A systematic population screening programme is not recommended.”
• “The UK NSC recommends piloting the use of the pulse oximetry test to evaluate the potential benefits of its use as a new screening test for congenital heart disease.”
[15] 2019 • “Recommendation against using pulse oximetry as an additional test in the newborn and infant physical exam”
  1. Abbreviations: AAP American Academy of Pediatrics, AEP Spanish Association of Paediatrics (Asociación Española de Pediatría), CCHD Critical congenital heart defect, CDC Centers for Disease Control and Prevention, NHS UK National Health Service, NICE National Institute for Health and Care Excellence, PO Pulse oximetry, RCPCH Royal College of Paediatrics and Child Health, UK NSC UK National Screening Committee, USPSTF US Preventive Services Task Force