Perfusion index, in addition to pulse oximetry may enhance detection of neonatal severe congenital heart disease

Objective To determine if addition of perfusion index (PIx) to oxygen saturation (SpO2) screening improves detection of critical congenital heart disease (CCHD) with systemic outflow obstruction. Study Design We determined screening thresholds for PIx and applied these to a cohort of newborns with and without congenital heart disease (CHD). Results A total of 123 normal and 21 CHD newborns (including five with critical systemic outflow obstruction) were enrolled. Four of these five critical systemic obstruction subjects passed SpO2-based screen. Four out of these five subjects failed PIx-based screen. The sensitivity for detection of systemic obstruction CCHD when compared with healthy infants increased from 20% (95% confidence interval [CI]: 1–72%) with SpO2 screening alone to 80% (95% CI: 28–100%) with combined SpO2-PIx screen. However, 2.44% of normal infants failed PIx screen. Conclusion Addition of PIx to SpO2 screening may detect additional cases of CCHD and further research is necessary to come up with optimal screening thresholds.

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Perfusion index in healthy newborns during critical congenital heart disease screening at 24 hours: retrospective observational study from the USA

BMJ Open ◽

10.1136/bmjopen-2017-017580 ◽

2017 ◽

Vol 7 (12) ◽

pp. e017580 ◽

Cited By ~ 5

Author(s):

Priya Jegatheesan ◽

Matthew Nudelman ◽

Keshav Goel ◽

Dongli Song ◽

Balaji Govindaswami

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Observational Study ◽

Oxygen Saturation ◽

Congenital Heart ◽

Selection Method ◽

Perfusion Index ◽

Data Selection ◽

Retrospective Observational Study ◽

Critical Congenital Heart Disease

ObjectiveTo describe the distribution of perfusion index (PI) in asymptomatic newborns at 24 hours of life when screening for critical congenital heart disease (CCHD) using an automated data selection method.DesignThis is a retrospective observational study.SettingNewborn nursery in a California public hospital with ~3500 deliveries annually.MethodsWe developed an automated programme to select the PI values from CCHD screens. Included were term and late preterm infants who were screened for CCHD from November 2013 to January 2014 and from May 2015 to July 2015. PI measurements were downloaded every 2 s from the pulse oximeter and median PI were calculated for each oxygen saturation screen in our cohort.ResultsWe included data from 2768 oxygen saturation screens. Each screen had a median of 29 data points (IQR 17 to 49). The median PI in our study cohort was 1.8 (95% CI 1.8 to 1.9) with IQR 1.2 to 2.7. The median preductal PI was significantly higher than the median postductal (1.9 vs 1.8, p=0.03) although this difference may not be clinically significant.ConclusionUsing an automated data selection method, the median PI in asymptomatic newborns at 24 hours of life is 1.8 with a narrow IQR of 1.2 to 2.7. This automated data selection method may improve accuracy and precision compared with manual data collection method. Further studies are needed to establish external validity of this automated data selection method and its clinical application for CCHD screening.

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