P3.091: Implementing Critical Congenital Heart Disease Screening in Rural Karnataka, India

Purpose/Objectives: Critical Congenital Heart Disease (CCHD) screening is a non-invasive, low-cost assessment that can detect potentially life-threatening structural heart disease in newborns. CCHD affects 3 in 1,000 newborns and often requires catheterization or surgery for treatment. The American Academy of Pediatrics (AAP) recommends CCHD screening for all newborns, utilizing an algorithm proposed by Kemper et al. in 2011, and revised in 2025. To provide equitable healthcare to vulnerable populations and reduce newborn mortality, we chose Vivekananda Memorial Hospital (VMH) as a pilot site in Karnataka, India. VMH serves a rural population of 300,000, including indigenous tribal communities living below the poverty line.

Universal CCHD screening in India faces challenges due to limited equipment, personnel, and infrastructure in rural government hospitals. Additionally, rural populations often lack access to cardiology specialty care for diagnostic echocardiograms after failed screening. As a quality improvement initiative, we introduced CCHD screening for newborns and assessed the feasibility and adoption of the initiative. Over 8 weeks, we trained hospital staff, provided necessary equipment, created workflows, and implemented an electronic health record to ensure testing at 24 hours of life or before hospital discharge.

Design/Methods: We collaborated with VMH pediatricians, trainees and nurses to implement universal CCHD screening. We delivered pulse oximetry equipment to VMH, discussed the importance of CCHD screening, conducted virtual training on proper use of the pulse oximeters, and taught an AAP-endorsed algorithm to determine passed/failed screens. Our project included longitudinal communication with VMH staff and real-time feedback on quality improvement measures to ensure sustainability.

Results: Of 77 newborns born at VMH from January to early March 2025, 76 were screened for CCHD, and one required emergent transfer at delivery for higher level of care. Ten infants who initially failed screening passed on repeat screening. Six of those infants were initially lost to follow-up, and efforts were made to re-test those newborns and re-educate staff. All 76 newborns ultimately passed CCHD screening. Screening rates for all newborns in the hospital increased from 0% to 99%, with 100% appropriate adherence to the screening algorithm.

Conclusion/Discussion: Our pilot program aimed to implement a screening program for CCHD in a rural hospital in India. With successful collaboration and training of local physicians and nurses, we developed a simple screening algorithm, implemented a local electronic health record, and created a referral process for failed screens. CCHD screening will be conducted on approximately 500 newborns born annually at VMH, with about 50 expected to fail initial screening and undergo further evaluation, and about 5 diagnosed with congenital heart disease. By detecting CCHD in rural hospitals and referring patients to urban specialists, we hope to facilitate collaboration between urban and rural healthcare providers, serving as a model for CCHD screening implementation in rural hospitals worldwide.