A pilot implementation study to detect neonatal critical congenital heart disease using pulse oximetry screening in Accra, Ghana

BACKGROUND: Congenital heart disease (CHD) is the leading congenital cause of death in newborns worldwide. Approximately one-quarter of CHDs are considered critical, requiring intervention during the first year of life to enable survival. While pulse oximetry screening (POS) for critical CHD (CCHD) is now standard in high-income countries, its use in low-resource settings remains limited. METHODS: This prospective cohort study aimed to: (1) assess the feasibility of implementing routine POS and (2) estimate the incidence of CCHDs in two large tertiary hospitals in Accra, Ghana with high delivery volumes. Eligible participants included all live-born infants less than 48 hours old who were not receiving supplemental oxygen at the time of enrolment. Newborns underwent POS, and those with positive POS screening were referred for echocardiography. RESULTS: Over the 1-year study period (February 2024 to January 2025), a total of 7889 deliveries were recorded at Korle-Bu Teaching Hospital and 37 Military Hospital. Among eligible infants, 96% (5725/5981) underwent POS screening. 29 newborns failed screening. CHD was confirmed in 19 cases (0.33% of all screened). Nine infants had CCHD (0.16%). Ten were diagnosed with non-CCHD (0.17%). CONCLUSIONS: POS was successfully implemented in two large tertiary hospitals in Accra, Ghana and identified newborns with CHD. Early detection of cases that would have otherwise gone undiagnosed underscores the importance of systematic screening for timely recognition. These findings support the integration of pulse oximetry into routine newborn care in resource-limited settings.