Early diagnosis of critical congenital heart disease in newborns: a systematic review of screening approaches

Critical congenital heart disease (CCHD) may be clinically silent during the first hours of life but can rapidly cause hypoxemia, systemic hypoperfusion, and decompensation after ductal closure.This review aimed to summarize current evidence on delayed CCHD diagnosis and to define a reproducible sequence for newborn screening. PubMed, Scopus, Web of Science, the Cochrane Library, ClinicalKey, and Google Scholar were searched for publications 2010–2025; after multi-stage selection 40 sources were retained for qualitative synthesis. Studies published in 2020–2025 were prioritized, whereas older publications were retained only when they provided foundational evidence on diagnostic accuracy or population-level screening outcomes.Pulse oximetry has very high specificity but incomplete sensitivity, therefore, a passing result does not exclude CCHD, particularly heart left-sided obstructive lesions. The most evidence-based approach involves a sequence that includes prenatal evaluation, clinical examination, measurement of oxygen saturation on the right hand and foot at a minimum age of 24 hours, and timely clinical evaluation in the event of a failed screening result. Under the 2025 American Academy of Pediatrics algorithm, screening is passed only when SpO2 is ≥ 95% at both sites and the difference is no more than 3 percentage points; an indeterminate result is repeated once after 1 hour.The practical screening effectiveness depends not only on the test itself, but also on documentation, access to echocardiography, and patient’s referral. For Ukraine, priorities include protocol standardization, staff training, result registration, and uninterrupted referral to pediatric cardiology services.