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Introduction:CHD affects over 1 million children in the United States. Studies show decreased mortality from CHD with newborn cardiac screening. California began a screening programme on 1 July, 2013. We evaluated the effect of mandatory screening on surgical outcomes at Loma Linda University Children’s Hospital since 1 July, 2013.Methods:We evaluated all infants having congenital heart surgery at Loma Linda University Children’s Hospital between 1 July, 2013 and 31 December, 2018. Primary target diagnoses include hypoplastic left heart syndrome, pulmonary atresia with intact ventricular septum, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus. Secondary target diagnoses include aortic coarctation, double outlet right ventricle, Ebstein anomaly, interrupted aortic arch, and single ventricle. Patients were stratified by timing of diagnosis (pre-screen, screen positive, and screen negative). Primary end points were post-operative length of stay, operative mortality, absolute mortality, and actuarial survival.Results:The cohort included 274 infants. Of these, 79% were diagnosed prior to screening (46% prenatally). Only 38% of those screened were positive, with 13% of the cohort having a “missed diagnosis.”Conclusions:Primary targets were more likely to be diagnosed by screening (53%), while secondary targets were unlikely to be diagnosed by screening (10%) (p = 0.004). Outcomes such as length of stay, operative mortality, and actuarial survival were not different based on timing of diagnosis (p > 0.05). Despite late diagnosis, those not diagnosed until after screening did not have adverse outcomes.

Introduction: Congenital heart disease (CHD) affects over one million children in the United States. Studies show mixed outcomes regarding a survival benefit from newborn cardiac screening (NCS). California began a NCS program on 7/1/13. We evaluated the effect of mandatory NCS on surgical outcomes of our program. Hypothesis: Neonates with critical CHD (CCHD), requiring surgery as infants, who are not diagnosed prior to or at the NCS have lower survival than those diagnosed prior to or at the NCS. Methods: We evaluated all infants with CCDH undergoing cardiac surgery at our center between 07/01/13 - 12/31/18. Subjects were stratified by timing of diagnosis (pre-screen, screen positive, screen negative). Sensitivity to detect specific lesions was calculated. Primary end-points were operative mortality, absolute mortality, and actuarial survival. Results: Two-hundred-seventy-four infants with CCHD were included. Seventy-nine percent were diagnosed prior to screening, while 8% were diagnosed by NCS, and 13% were screen negative. Total anomalous pulmonary venous return (TAPVR) (47%) and aortic coarctation (CoA) (40%) were the most likely to be undiagnosed at time of NCS (p0.05) (Figure). Conclusions: We found only a 38% sensitivity of mandatory newborn CCHD screening to detect target cardiac lesions requiring surgery in the first year of life. A high proportion of newborns with HLHS, TOF, and CoA remained undiagnosed after screening, though TAPVR was readily detected. There were no differences in survival between the screening groups. Mandatory newborn CCHD pulse oximetry screening can detect some newborns with critical heart disease, but should not replace traditional methods of monitoring in the fetal, newborn, and infant periods.