Low false‐positive rate of perfusion index as a screening tool for neonatal aortic coarctation

Lannering, Katarina; Elfvin, Anders; Mellander, Mats

doi:10.1111/apa.15661

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…Indeed, combined POS and PI increased sensitivity for detection of systemic critical outflow obstruction to 80% (from 20% with POS alone) [ 24 ]. However, there remains a lack of consensus on determining the appropriate cut-off values, and false positive rates are high, although repeat PI measurements with screening at > 12 h may help lower these [ 40 ]. Thus, further evaluation of screening protocols in larger trials is required to ascertain the potential clinical impact before its adoption in the routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Singh

Chen

2021

Eur J Pediatr

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Pulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50–70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%.Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools. What is Known:• Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects.• Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee. What is New:• To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Singh

Chen

2021

Eur J Pediatr

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“…Un parámetro que los autores consideran de utilidad clínica para ser tomado en cuenta, de forma adjunta a la OP durante la realización del TNC es el IP, mismo que a pesar de su potencial importancia, ha sido hasta el momento infraestimado, probablemente por las observaciones existentes de su alta variabilidad en un corto periodo de tiempo, llevando a resultados falsos positivos, problema que podría ser subsanado con la realización de mediciones repetidas. 105,106 Se trata de la estimación indirecta y no invasiva de la perfusión periférica (indicativo de la fuerza de la señal del pulso arterial), a través de la fuerza pulsátil de un sitio corporal específico de estudio, como una mano o un dedo, por ejemplo, calculada mediante la relación del componente corriente alterna y corriente continua de la fotopletismografía. 46,53 De acuerdo con el estudio de Wren y colaboradores en Reino Unido, alrededor de 30% de pacientes con CCC fueron diagnosticados posterior al alta hospitalaria.…”

Section: íNdice De Perfusiónunclassified

“…108 Cabe mencionar que el diagnóstico tardío de la coartación aórtica (prevalencia reportada en alrededor de 4/10,000 RN vivos) 109 y de otras alteraciones obstructivas izquierdas, siguen representando un problema por las implicaciones en aspectos de morbimortalidad de quienes las padecen. 106 En 2018, Uygur, en Taiwán, dio a conocer su estudio prospectivo en 3,175 RN. Se midió la OP, el IP y se realizó un examen físico dirigido.…”

Section: íNdice De Perfusiónunclassified

Tamiz neonatal cardiaco: beneficios de su implementación en México

2022

Revista Mexicana De Pediatría

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The neonatal cardiac screen is a simple, non-invasive, painless and cost-effective test, with which critical congenital heart disease can be detected in a timely manner. Diseases that can cause serious sequelae or death of newborns, if not diagnosed in time. These malformations require some type of invasive procedure during the first month of life. According to the algorithms published as of 2011, it is performed by measuring pulse oximetry in the right hand and either of the two feet of neonates, with sequential measurements and established cut-off points. In Mexico, in compliance with national and international regulations, the screening has been implemented in some States of the Republic, with its addition as a screening test in the general health law in 2021, which makes it a mandatory study in the Mexican territory. In this document, global background, scientific, technical, operational, regulatory and economic aspects for the proper performance of screening are exposed, also proposing modifications to the algorithm and making known the analysis carried out on the costs and benefits of the Neonatal Cardiac Screen. The objective of making adjustments to the algorithm is to adapt to the demographic conditions of the Mexican population, in such a way that the number of false positives and false negatives related to geographic altitude and the measurement of the perfusion index can be reduced.

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“…10,11 In their study, published in this edition of Acta Paediatrica, Lannering et al have investigated the effect of introducing repeated measurements of abnormal results (similar to the repeated measurements recommended for pulse oximetry screening) to reduce the false-positive rate in PI screening. 12 They recorded pre-and post-ductal PI in a total of 513 apparently healthy term newborns at the same time as oxygen saturations were measured as part of POS (median age 18 h). This included an initial pilot of 50 babies with up to 3 immediate repeats if PI was below the pre-determined cut-off of 0.7.…”

Section: Editorialmentioning

confidence: 99%

“…In their study, published in this edition of Acta Paediatrica , Lannering et al have investigated the effect of introducing repeated measurements of abnormal results (similar to the repeated measurements recommended for pulse oximetry screening) to reduce the false‐positive rate in PI screening 12 …”

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confidence: 99%

Perfusion index as a screening test for neonatal aortic coarctation: Should we be using it routinely?

Ewer

2021

Acta Paediatrica

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Low false‐positive rate of perfusion index as a screening tool for neonatal aortic coarctation

Abstract: This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 8 publications

References 29 publications

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Impact of pulse oximetry screening to detect congenital heart defects: 5 years’ experience in a UK regional neonatal unit

Tamiz neonatal cardiaco: beneficios de su implementación en México

Perfusion index as a screening test for neonatal aortic coarctation: Should we be using it routinely?

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