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Impact of Newborn Pulse Oximetry Screening on Early Detection of Critical Congenital Heart Disease in Nigerian Hospitals

Abstract

Critical congenital heart disease (CCHD) represents an important cause of neonatal morbidity and mortality and may remain undetected during the early postnatal period when newborns appear clinically stable. Delayed identification of CCHD can result in cardiovascular deterioration, hypoxaemia, shock, heart failure, and death before definitive diagnosis and treatment are provided. Newborn pulse oximetry screening provides a simple, non-invasive method of measuring oxygen saturation and may help identify newborns with possible CCHD who require further clinical assessment and diagnostic echocardiography. In Nigeria, however, limited availability of pulse oximetry equipment, inadequate healthcare-worker training, inconsistent screening protocols, limited access to paediatric cardiology and echocardiography services, and weak referral systems may affect the implementation and effectiveness of newborn screening programmes. Against this background, this study investigates the impact of newborn pulse oximetry screening on the early detection of critical congenital heart disease in Nigerian hospitals. The study will be anchored on the Health Belief Model, Health Systems Framework, and Social Ecological Model. The Health Belief Model explains how parents' and healthcare workers' perceptions of the seriousness and benefits of early CCHD detection may influence acceptance and implementation of newborn screening. The Health Systems Framework emphasizes service delivery, health workforce, medical technologies, health information systems, financing, governance, and accessibility as essential components of effective newborn screening and referral services. The Social Ecological Model emphasizes the influence of individual, family, healthcare facility, community, and broader policy factors on newborn screening and access to appropriate cardiac care. Collectively, these theoretical perspectives provide a suitable framework for explaining how pulse oximetry screening may influence early detection of CCHD in Nigerian hospitals. The study will adopt a quantitative analytical cross-sectional, prospective cohort, or quasi-experimental research design depending on the availability of screening records and the implementation structure of participating hospitals. The study population will comprise newborns delivered or admitted in selected Nigerian hospitals. A multistage sampling technique will be used to select states, local government areas, hospitals, maternity units, neonatal units, and eligible newborns. Newborn pulse oximetry screening will be assessed using indicators such as availability of functional pulse oximeters, screening coverage, timing of screening after birth, screening protocol adherence, oxygen saturation measurements, repeat testing where indicated, healthcare-worker training, documentation of results, and referral following abnormal screening results. Early detection of CCHD will be assessed using indicators such as abnormal screening results, clinical suspicion of congenital heart disease, timing of identification, echocardiographic confirmation where available, referral to paediatric cardiology services, confirmed CCHD cases, and time between abnormal screening and diagnostic evaluation. Data will be collected using structured questionnaires, newborn screening registers, pulse oximetry records, maternity and neonatal records, echocardiography reports, referral registers, and hospital medical records. Descriptive statistics will be used to summarize newborn characteristics, screening coverage, oxygen saturation findings, referral patterns, and CCHD detection outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of pulse oximetry screening on early CCHD detection. Where a quasi-experimental design is adopted, CCHD detection before and after implementation of a structured pulse oximetry screening programme may be compared, while relevant newborn and facility-level factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that newborn pulse oximetry screening has a significant positive impact on the early detection of critical congenital heart disease in Nigerian hospitals. Newborns who undergo routine pulse oximetry screening are expected to have a higher likelihood of suspected CCHD being identified before clinical deterioration compared with newborns without access to systematic screening. Early identification may facilitate prompt clinical assessment, echocardiographic diagnosis, specialist referral, stabilization, and timely intervention. Pulse oximetry screening may also identify some newborns with hypoxaemia who do not initially present with obvious clinical signs. However, the effectiveness of screening may be limited by false-positive or false-negative results, inadequate screening protocols, poor equipment availability, insufficient healthcare-worker training, limited access to confirmatory echocardiography, and delayed referral to specialized cardiac services. The study therefore expects systematic pulse oximetry screening, supported by appropriate clinical assessment, confirmatory diagnosis, and effective referral pathways, to contribute significantly to improving early CCHD detection and newborn survival in Nigeria. The study is expected to contribute to the literature on newborn pulse oximetry screening, critical congenital heart disease, congenital heart disease detection, neonatal screening, newborn health, paediatric cardiology, neonatal healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospital administrators, paediatricians, neonatologists, paediatric cardiologists, nurses, midwives, medical laboratory and diagnostic personnel, development partners, and policymakers regarding strategies for strengthening newborn screening services. The study will also provide evidence-based recommendations for expanding newborn pulse oximetry screening, improving access to functional screening equipment, strengthening healthcare-worker training, standardizing screening and documentation protocols, improving access to echocardiography and paediatric cardiology services, strengthening referral systems, and integrating CCHD screening into broader newborn and child health programmes across Nigerian hospitals.

Keywords: Newborn pulse oximetry screening, critical congenital heart disease, CCHD, early detection, neonatal screening, congenital heart disease, oxygen saturation, echocardiography, newborn health, Nigerian hospitals, public health.