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CCHD Screening Algorithm (2025 Update)

flowchart TD
    A[Newborn >24 hours of life<br/>or before discharge] --> B[Pulse Oximetry<br/>Right Hand + Either Foot]

    B --> C{Any reading <90%?}

    C -->|Yes| D[FAIL<br/>Immediate Echo]
    C -->|No| E{Both locations ≥95%<br/>AND difference ≤3%?}

    E -->|Yes| F[PASS]
    E -->|No| G{90-94% in either location<br/>OR >3% difference?}

    G -->|Yes| H[RETEST in 1 hour<br/>Only 1 retest allowed!]

    H --> I{After retest:<br/>Both ≥95% AND ≤3% difference?}

    I -->|Yes| F
    I -->|No - Still 90-94%<br/>or >3% difference| D

    D --> J[Echocardiogram +<br/>Evaluate for non-cardiac causes]

    J --> K{Cardiac diagnosis?}
    K -->|Yes| L[Cardiology Management]
    K -->|No| M[Consider PPHN, Pneumonia,<br/>Sepsis, other causes]

    F --> N[Discharge with<br/>warning sign education]

    style D fill:#ff6b6b
    style F fill:#90EE90
    style H fill:#ffd93d
📋 Text Version (if diagram doesn't render) **CCHD Screening Algorithm (2025)** 1. **Newborn >24 hours** → Pulse oximetry: Right hand + Either foot 2. **Any reading <90%?** → **FAIL** → Immediate echo 3. **Both ≥95% AND difference ≤3%?** → **PASS** → Discharge with warning sign education 4. **90-94% in either OR >3% difference?** → RETEST in 1 hour (only 1 retest allowed!) 5. **After retest still 90-94% or >3% difference?** → **FAIL** → Echo + evaluate for non-cardiac causes

2025 Key Updates

Feature 2011 Algorithm 2025 Algorithm
Pass threshold ≥95% either extremity ≥95% BOTH extremities
Retests allowed 2 1 only
Complexity More complex Simplified

Target Lesions (Primary 7)

  1. Hypoplastic left heart syndrome
  2. Pulmonary atresia (intact septum)
  3. Tetralogy of Fallot
  4. Total anomalous pulmonary venous return
  5. Transposition of great arteries
  6. Tricuspid atresia
  7. Truncus arteriosus

Limitations

Commonly Missed

  • Coarctation of aorta (most common miss)
  • Critical aortic stenosis
  • Interrupted aortic arch

False Positive Causes

  • Transition physiology
  • PPHN
  • Respiratory disease
  • Sepsis

Important Teaching Points

  1. PASS ≠ no CHD - sensitivity only 50-76%
  2. Coarctation presents AFTER discharge when ductus closes
  3. Pre-ductal MUST be right hand (not left)
  4. Educate families on warning signs at discharge