Neonatal cyanotic congenital heart disease (CCHD) is a life-threatening emergency requiring prompt recognition and timely bedside decision-making. However, existing guidelines do not provide a validated, comprehensive point-of-care (POC) protocol specifically designed for frontline clinicians across diverse healthcare settings. The GiriMok POC Protocol was developed to address this gap and support standardized early management of neonates with suspected CCHD.

This study aimed to develop and establish the content validity of the GiriMok Protocol through a rigorous four-phase iterative multidisciplinary expert validation process. The methodology comprised two external validation phases and two author-led refinement phases. In Phase 1, 18 multidisciplinary experts evaluated the protocol using a 33-parameter mixed-methods assessment instrument. Following incorporation of expert feedback, a focused revalidation was conducted by five specialists, including neonatologists and a pediatric cardiologist, using a 16-item instrument. Agreement was quantified using the modified kappa (k*) statistic. Subsequent phases involved evidence-based refinement aligned with contemporary guidelines (2023–2025) and final quality assurance review. Content validity was assessed using item-level (I-CVI) and scale-level (S-CVI/Ave) Content Validity Indices.

A total of 18 unique experts participated across 24 validation episodes. Phase 1 demonstrated excellent content validity, with an S-CVI/Ave of 0.927, all items achieving the predefined I-CVI threshold of ≥0.78, and no safety concerns identified. Integration of a 22-item revision agenda resulted in substantial protocol enhancement. Phase 2 achieved perfect agreement, with both S-CVI/Ave and k* values of 1.000. Overall, 35 expert-informed modifications were incorporated, culminating in the final publication-ready GiriMok Version 4.0.

The GiriMok POC Protocol achieved unanimous multidisciplinary validation and demonstrated outstanding content validity. These findings support its readiness for prospective clinical evaluation and wider dissemination as a standardized neonatal emergency decision-support tool.

Syed Moiz Ahmed is an Associate Professor of Pediatrics and Consultant Neonatologist at a medical school in India. He completed his MBBS and postgraduate training (MD) in Pediatrics in India, followed by a three-year DM Neonatology fellowship from India. His clinical and academic interests encompass neonatal intensive care, neonatal hemodynamics, and point-of-care ultrasonography. He has authored numerous national and international peer-reviewed publications and has contributed chapters to neonatal medicine textbooks. He has also completed a six-month advanced online training program in point-of-care ultrasound (POCUS) and neonatal functional echocardiography. His current areas of interest include neonatal functional echocardiography, hemodynamic assessment.