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Coarctation of the Aorta- Delay in Diagnosis and Referral Basis from Infancy to Adult Age. OBJECTIVES: To assess the role of neonatal pulse oximetry screening and other bases of referral for patients of all ages with aortic coarctation referred to a tertiary care medical center. STUDY DESIGN: Medical records were reviewed for 200 consecutive patients diagnosed and treated for coarctation in either 2006-2011 or 2015-2019, before and after mandated pulse oximetry screening. RESULTS: For both groups ∼50% of patients were diagnosed in the first 5 days. Fetal echocardiography diagnosis was more frequent in the 2015-2019 group (30.5% vs 20.5%, P < .03); obstruction often developed only as the ductus arteriosus closed. For each group ∼25% of patients were diagnosed >1 year of age and 7% had incidental diagnosis. Pulse oximetry screening was documented to be abnormal in only 8 of 47 patients and was not performed in those with fetal diagnosis. Evaluation of a murmur was the second most frequent basis for referral. Moderate-to-severe left ventricular dysfunction occurred mainly in infants in the first month with similar frequency in both groups; these patients often had tachypnea or poor weight gain. Decreased femoral pulses or systemic hypertension were infrequently documented by referring physicians. Hypertension typically was ascribed to a renal or essential basis. Exercise symptoms occurred mainly in patients >10 years. CONCLUSIONS: Although fetal echocardiography and neonatal pulse oximetry contribute to the diagnosis of coarctation, physical examination has an important complementary role. Evaluation of peripheral pulses on initial and early follow-up neonatal examinations, and consideration of coarctation in any patient with hypertension are needed to improve timely detection.