Key result
Pulse oximetry combined with clinical examination improves congenital heart disease screening sensitivity to ~88%.
Why the study?
Screening for congenital heart disease (CHD) reduces neonatal morbidity and mortality, yet implementation in developing countries is constrained by infrastructure, healthcare workforce capacity, and limited policy integration. This review evaluated the diagnostic performance of CHD screening modalities, analyzed constructs influencing screening success, and developed a conceptual implementation model.
What is the diagnostic performance of congenital heart disease screening modalities in neonates, and what constructs determine implementation success?
Systematic Review
What is the diagnostic performance of congenital heart disease screening modalities in neonates, and what constructs determine implementation success?
Combining pulse oximetry with clinical examination improves sensitivity (83-93%) for neonatal congenital heart disease screening, though successful implementation in developing regions requires addressing systemic barriers like clinical competence, equipment availability, and referral infrastructure.
Answers are grounded in this paper and cite their sources.
Emphasizes infrastructure and policy needs for CHD screening in developing countries; extends evidence on modality performance and implementation factors.
Screening for congenital heart disease (CHD) is a priority public health intervention to reduce neonatal morbidity and mortality, yet implementation in developing countries is constrained by infrastructure, healthcare workforce capacity, and limited policy integration. This review aimed to: (1) evaluate the diagnostic performance, defined as the sensitivity and specificity of CHD screening modalities, (2) analyze the constructs influencing screening success and their interrelationships, and (3) develop a conceptual model of implementation. A systematic literature review was conducted following the PRISMA 2020 guidelines, with searches performed in Scopus and Web of Science (2015-2025), yielding 63 high-quality articles, which were assessed using the MMAT 2018 and analyzed thematically with NVivo 14. Pulse oximetry screening demonstrated a sensitivity of 75-81% and a specificity of 97-99%, increasing to 83-93% when combined with clinical examination, however, implementation remained geographically concentrated in North America and Western Europe. Twelve constructs were identified as associated with screening success, with clinical competence and equipment availability being the most frequently reported, followed by program awareness, quality assurance, data monitoring, and referral systems. Thematic synthesis revealed a multilayered conceptual structure in which constructs appear to function as direct determinants, potential mediators, or contextual moderators of screening success, though causal directionality requires empirical validation. The success of CHD screening programs is associated with the systemic synergy among technical competence, technological infrastructure, policy and financial support, referral systems, and active family and community participation, supporting a multidimensional approach to strengthen neonatal screening and reduce infant mortality.
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Koentartiwi et al. (2026) conducted a systematic review in Congenital heart disease (CHD) in neonates. Congenital heart disease screening modalities (pulse oximetry alone or combined with clinical examination) was evaluated on Diagnostic performance (sensitivity and specificity) and constructs influencing screening implementation success. Pulse oximetry screening showed 75-81% sensitivity and 97-99% specificity for congenital heart disease, rising to 83-93% sensitivity when combined with clinical examination.
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