Investigating the Implementation Process of Clinical Guidelines for Early Diagnosis of Critical Congenital Heart Disease at Birth Using Pulse Oximetry in Isfahan

Congenital heart disease is one of the most common birth defects. This study aims to examine the process of clinical guideline implementation to identify strengths and weaknesses.

In this cross-sectional study, healthy term and term neonates born from January 2023 to July 2023 were evaluated at Shahid Beheshti Hospital in Isfahan. The data collection tool was a checklist. The pulse oximetry (POX) was performed for healthy newborns within the first 24 hours after birth and before discharge from the hospital. Oxygen saturation (SpO2) < 89% in the baby's hand and foot was considered positive screening. If the SpO2 level was between 90-94%, the screening was repeated one hour later and if in the case of the same results, the newborn was referred to a specialist for further assessment. Healthy neonates with positive test results were followed up two months after primary POX screening.

Out of 500 neonates, 472 (94.4%) had a SpO2 level ³ 95%. Among the 21 cases who had a positive screening, one case had cardiac diseases (i.e., complete atrioventricular septal defect/pulmonary hypertension). Two healthy neonates with a positive screening were diagnosed with PFO after two months of follow-up. The assessment of the implementation process of newborn screening based on the checklist recommendations of clinical guidelines increased from 58.3 % to 91.6 % within six months.

The implementation of the critical congenital heart disease clinical guideline was found to be favorable and acceptable in this study and recommended for other hospitals to implement.