Critical Congenital Heart Disease (CCHD) Newborn Screening

Washington has required critical congenital heart disease (CCHD) newborn screening since July 2015. State law (RCW 70.83.090) makes it a point-of-care newborn screen and requires Washington providers to follow the American Academy of Pediatrics (AAP) protocol.

The screen uses pulse oximetry. It’s a painless and non-invasive method. Beams of light estimate the percentage of oxygen in a baby’s blood, which gives an estimate of how well the heart is working. Screening newborns for CCHD helps find life-threatening heart defects before a newborn has any symptoms. That information gives care teams time to treat a newborn early and helps improve the newborn’s health outcomes.

What is CCHD?

Congenital heart disease (CHD) is a group of conditions that change the structure or function of the heart from birth. CCHD is the more severe subset. These defects or abnormalities can cause life-threatening symptoms and usually need early medical treatment.

Finding CCHD through screening before a newborn leaves the hospital lowers the risk of serious complications and even death.

How Is a Newborn Screened for CCHD?

Screening happens in 2 settings:

  • Before birth: Prenatal screening uses ultrasound and fetal echocardiography.
  • After birth: Newborns in Washington get a pulse oximetry at 24 hours of life. The screen measures oxygen saturation in the right hand and the foot. A screen after the baby is born is needed because prenatal screening does not find all CCHDs.

A baby passes when both readings are 95% or higher and differ by no more than 3%. A failed screen is repeated once. If it fails again, the infant is referred for a follow-up to their provider.

What Changed in the 2024 AAP Algorithm?

AAP endorsed a simplified CCHD screening algorithm in 2024. The new screening algorithm reduces ambiguity and variability in interpretation.

2024 AAP CCHD Guidelines

  • Oxygen Saturation Requirement: Both hand and foot must be above 95%.
  • % Difference in Saturation: No more than 3% difference between hand and foot.
  • Rescreening: 1 rescreen for uncertain test results. Eliminates the second rescreen if a newborn falls into the retest category. This allows for earlier evaluation and treatment.

Read the updated guidelines announcement: AAP updates recommendations on use of pulse oximetry to screen newborns for critical congenital heart disease.

Pulse Oximetry Protocol
Pulse Oximetry Protocol document thumbnail.

Pulse Oximetry Protocol (PDF)

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Answers to More Commonly Asked Questions

What is the difference between CHD and CCHD?

Congenital heart disease covers a range of heart defects present at birth. They vary in severity and some need little to no intervention. CHD is the most common cause of death in the first year of life.

Critical congenital heart disease is a more severe subset of CHD. It is life-threatening and requires surgery within the first year of life.

How common are CHD and CCHD?

CHD is the most common birth defect in the United States and affects nearly 1% of births. About 25% of infants with CHD have a critical form. In Washington, about 100 infants are diagnosed with CCHD on average each year.

Exact counts vary because there’s no standard definition of CCHD across the screening spectrum.

What qualifies as a CCHD in Washington?

By law, an infant born with any congenital heart defect that needs medical treatment in the first year of life is considered a CCHD case in Washington.

The Washington State CCHD Workgroup uses a narrower working definition. It counts an infant born with any congenital heart defect that needs cardiac (heart) surgery or interventional catheterization within the first month of life.

Where does CCHD screening happen?

It depends on where your baby is born. In a hospital, the screen may happen at the bedside, in a triage room, or in the Neonatal Intensive Care Unit (NICU). If your baby is born outside a hospital, many midwives in Washington carry pulse oximeters and can do the screening themselves.

When does CCHD screening happen?

Newborns in Washington are screened at 24 hours after birth. State rule WAC 246-650-035 has set that timing.

What is a pulse oximeter?

A pulse oximeter is a device that measures the oxygen saturation in an infant’s blood. A provider wraps a probe around the infant’s right hand and foot to measure the oxygen saturation in the blood. The CCHD screen is non-invasive, meaning it doesn’t break the skin or cause any pain.

I don’t live in Washington, but I plan to have my baby there. Will my baby be screened for CCHD? 

Yes. All babies born in Washington, regardless of residency, are screened for CCHD as part of the state’s required screening program. You can choose to opt out of this screening.

Washington State CCHD Workgroup

The Washington State CCHD Workgroup is a partnership between the Washington State Department of Health, Providence Sacred Heart Children’s Hospital Spokane, Seattle Children’s Hospital, and MultiCare Mary Bridge Children’s Hospital, Tacoma.

The group meets periodically to review CCHD diagnosis data. It also gives guidance and recommendations to providers screening newborns for CCHD in Washington.

Have a Question?

Please email the Genetics Program at Genetics@doh.wa.gov.

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