Congenital heart disease is a frequently encountered congenital anomaly in the neonatal period. Studies have confirmed that neonatal examination and murmur can not be considered reliable signs in newborns, elevating the chances of skipping the detection of underlying heart problems. 

Missed routine neonatal screening renders a 25% possibility of missing congenital heart disease, and 40% of these cases may present with shock and circulatory collapse in the hospital in the subsequent days. Since the delay in diagnosis may increase neonatal mortality, all newborn babies should receive screening before discharge. All babies who fail pulse oximetry threshold of <95% must receive screening by preductal and post-ductal pulse oximetry as underlying hypoxemia may be missed clinically. 

Studies have proven that if a newborn receives screening within the first week, the chances of missing cardiac problems drop dramatically to less than 30%. The burden and severity of this illness prompted the American Academy of Pediatrics and the American Heart Association to recommend conducting neonatal screening in all developed, affordable countries. 

Physicians and policymakers in developing countries should be aware of detecting critical heart disease at the right time and implementing policies so that intervention can be done timely to prevent neonatal mortality.

All the strategies must aim to improve neonatal survival rates and decrease neonatal mortality and morbidity. 

Lakra MS, et al. Pulse Oximetry Screening of Newborn for Critical Congenital Heart Disease in Developing Countries. Pediatr Neonat biol 2022, 7(1): 000162.