Toward National Implementation of Pulse Oximetry Screening for Critical Congenital Heart Disease in Türkiye: A Multicenter Survey of Neonatal Centers

Background Pulse oximetry screening for critical congenital heart disease (CCHD) is an established adjunct to routine newborn assessment and has increasingly been incorporated into organized screening programs. In Türkiye, center-level adoption has expanded over the last decade, and nationwide implementation is planned within the Ministry of Health screening framework. We aimed to assess current screening practices, documentation systems, and institutional perspectives relevant to national scale-up across neonatal centers in Türkiye. Methods We conducted a cross-sectional, web-based survey of neonatal centers in Türkiye under the coordination of the Scientific Commission of the Turkish Neonatology Society. After center-level review for duplicate submissions and data cleaning, 82 unique centers were included in the final analysis. Survey domains included institutional characteristics, current CCHD pulse oximetry screening practice, documentation systems, personnel involved in screening, perceived cost-effectiveness, support for inclusion in a national screening program, and implementation barriers. Analyses were primarily descriptive; exploratory comparative analyses were also performed according to hospital type and neonatal unit level. Results Participating centers represented 33 provinces in Türkiye. Current CCHD pulse oximetry screening was reported by 79 of 82 centers (96.3%). Manual documentation remained the dominant recording method (70.7%), whereas only 15.9% of centers reported digital recording systems. Most respondents considered screening cost-effective (80.2%), supported inclusion in a national screening program (81.7% definite support), and favored a centralized recording system (79.3%). The most frequently reported barriers were device/infrastructure limitations (39.0%), insufficient trained personnel (25.6%), and lack of standardization (12.2%). In exploratory analyses, physician involvement in screening was more common in academic centers, while disposable probe use was less frequent in higher-level neonatal units. Conclusions CCHD pulse oximetry screening is already widely adopted across responding neonatal centers in Türkiye, suggesting strong professional acceptance ahead of national rollout. However, broad clinical uptake should not be equated with full implementation maturity. Persistent gaps in digital data systems, workforce capacity, and protocol standardization indicate that coordinated system-level support will be essential for equitable, high-quality national implementation.