Role of Pulse Oximetry Screening for Term Healthy Newborns During Transitional Period to Detect Critical Congenital Heart Disease (CCHD): A Prospective Observational Study in a Tertiary Care Hospital

Background: Early detection of critical congenital heart disease (CCHD) remains a challenge, especially in settings with early postnatal discharge. Pulse oximetry screening is a simple, non-invasive method that can aid in early diagnosis, but optimal timing in resource-limited settings requires evaluation. Objective: This study aims to assess the effectiveness of pulse oximetry screening at 15 minutes and six hours of life in identifying persistent hypoxemia and detecting CCHD or other early echocardiographic cardiac findings among term healthy newborns. Methods: This prospective observational study was conducted over six months in a tertiary care hospital and included 530 term newborns with birth weight ≥2.5 kilograms (kg). Oxygen saturation (peripheral capillary oxygen saturation (SpO₂)) was measured at 15 minutes and six hours of life. Newborns with SpO₂ <95% were reassessed, and those with persistent abnormal values or limb saturation difference ≥3% underwent echocardiography. Data were analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York). Results: Of 530 newborns, 81 (15.3%) had SpO₂ <95% at 15 minutes. At six hours, 75 were normalized, while six newborns (1.13%) had persistent abnormal screening findings and underwent echocardiography. Among these, two newborns (0.37%) were diagnosed with CCHD, and four had patent ductus arteriosus (PDA) detected on early echocardiography. Because echocardiography was performed during the early neonatal transitional period, PDA findings may have been physiological and were not confirmed as persistent CHD by follow-up echocardiography. Newborns delivered by lower segment cesarean section (LSCS) showed a higher incidence of low SpO₂ compared to normal vaginal delivery (NVD). Conclusion: Early pulse oximetry screening at 15 minutes and six hours is a practical approach for identifying term newborns with persistent hypoxemia who may require further cardiac evaluation before discharge. This approach may be feasible for routine neonatal care, particularly in settings with early discharge practices; however, larger studies with follow-up are needed to define diagnostic accuracy, false-negative rates, and the clinical significance of early PDA findings.