Abstract
<title>Abstract</title> <p> Background: Congenital heart disease (CHD) is the most common congenital anomaly and a leading cause of neonatal morbidity and mortality. A significant proportion of critical congenital heart disease (CCHD) remains undetected at birth when reliance is placed solely on antenatal screening and clinical examination. Pulse oximetry has emerged as a simple, non-invasive screening tool for early detection of hypoxemia associated with CCHD. Objectives: To evaluate the effectiveness of newborn pulse oximetry screening for detection of CHD in a tertiary care hospital and to analyze the demographic, clinical, and antenatal characteristics of screen-positive neonates. Methods: This prospective observational study included <bold>13,120 newborns</bold> screened using standardized pre-ductal and post-ductal pulse oximetry prior to discharge. Newborns with positive screening results underwent detailed echocardiographic evaluation. Screening performance and the spectrum of detected cardiac lesions were analyzed. Results: Pulse oximetry screening identified <bold>45 newborns (0.34%)</bold> as screen positive. Among these, <bold>31 (68.9%)</bold> had critical CHD and <bold>14 (31.1%)</bold> had non-critical CHD. The majority of affected infants were term (mean gestational age 38.1 weeks) and had normal birth weight (mean 2.86 kg). Tetralogy of Fallot was the most common lesion, followed by double outlet right ventricle and transposition of the great arteries. Over one-quarter of infants with CHD were asymptomatic at detection, including some with critical lesions. Most cases occurred in the absence of identifiable antenatal risk factors. Conclusion: Newborn pulse oximetry screening is an effective, feasible, and highly specific method for early detection of CHD, particularly critical lesions, in term neonates. Universal implementation of pulse oximetry screening can significantly reduce missed diagnoses and facilitate timely referral and intervention, especially in resource-limited settings. </p>