Diagnostic values of the femoral pulse palpation test

Abstract

ObjectivesTo calculate diagnostic values of the femoral pulse palpation to detect coarctation of the aorta or other left-sided obstructive heart anomalies in newborn infants.DesignPopulation-based cohort study.SettingStockholm-Gotland County 2008–2012.PatientsAll singleton live-born infants without chromosomal trisomies, at ≥35 gestational weeks, followed-up until 1–2 years of age.Main outcome measuresDiagnostic values and ORs for the femoral pulse test and subsequent diagnosis of coarctation of the aorta or left-sided obstructive heart malformation.ResultsAmong the 118 592 included infants, 432 had weak or absent femoral pulses at the newborn examination. Seventy-eight infants were diagnosed with coarcation of the aorta and 48 with other left-sided obstructive heart malformations. The diagnostic values for the femoral pulse palpation test to detect coarctation of the aorta were: sensitivity: 19.2%, specificity: 99.6, positive predictive value: 3.5% and negative predictive value: 99.9%. For left-sided heart malformations: sensitivity: 8.3%, specificity: 99.6%, positive predictive value: 0.9% and negative predictive value: 100%. Sensitivity for coarctation of the aorta increased from 16.7% when examined at <12 hours of age to 30.0% at ≥96 hours of age.ConclusionsThe femoral pulse test to detect coarctation of the aorta and left-sided heart malformations has limited sensitivity, whereas specificity is high. As many infants with life-threatening cardiac malformations leave the maternity ward undiagnosed, further efforts are necessary to improve the diagnostic yield of the routine newborn examination.

The Stockholm–Gotland perinatal cohort—A population‐based cohort including longitudinal data throughout pregnancy and the postpartum period

“…Characteristics of the SGPC cohort, stratified by the calendar periods 2008–2014 and 2015–2020, are presented in eTable S4. A summary of the studies we have published 1–28 using the SGPC population including singleton births between 1 January 2008 and 22 October 2014 ( N = 175,522) is summarised below.…”

“…Additional infant studies, benefiting from using the SGPC enriched with register data, 13,19 include a study on the association between neonatal hypoglycaemia and adverse neurodevelopment at 2–6 years of age. Moderate neonatal hypoglycaemia was associated with an increased risk of developmental delay, even after controlling for confounding 13 .…”

“…Another study, assessing the diagnostic values of the femoral pulse palpation test (part of the 21‐item newborn examination), showed that femoral pulse palpitation had low sensitivity and high specificity for detecting congenital heart malformations. Given that a missed diagnosis could lead to major disability or death, we concluded that there is a need for improved methods to detect such malformations 19 …”

“…In previously published studies 1–28 using the SGPC including singleton births between 1 January 2008 and 22 October 2014, we have with the rich data been able to fill many previous knowledge gaps. However, we have in these studies explored only a small part of the data in the SGPC.…”

“…The SGPC is further enriched with data from 10 National Health Care and Quality Registers. Initially, SGPC covered singleton births up to 22 October 2014 ( N = 175,522), and numerous studies have been published using this study population 1–28 . Recently, the cohort has been updated to include all births until 15 June 2020 ( N = 335,153 singleton and N = 11,025 multiple pregnancies).…”