Oxygen Saturation and Perfusion Index-Based Enhanced Critical Congenital Heart Disease Screening

Abstract

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.

A novel system to collect dual pulse oximetry data for critical congenital heart disease screening research

“…That study and prior studies evaluated PIx for a single moment in time with an artifact-free waveform for 10 s. In our current study, we averaged the pulse amplitude index (PAI), which is PIx multiplied by 100, over 5 min. We captured a patient with CoA and demonstrated the foot PAI decrease, as the ductus arteriosus was closing, and decreased below thresholds that may be indicative of systemic obstruction such as CoA [11,18]. Interestingly, we noted this decrease in PAI when the echocardiogram estimated only a mild CoA and thus it was initially thought the baby may not require surgery.…”

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

“…19 Siefkes et al used a cut-off <0.5% in a group of newborns with LHOD (with and without prenatal diagnosis) at 24 h of age. 16 3 out of 5 newborns had post-ductal PI values below cut-off with a high false-positive rate of 2.4%. If using a cut-off of 0.7%, 4 out of 5 would fail the PI screen.…”

“…27 A number of studies have investigated the clinical use of PI in screening for CCHD [15][16][17][18][19]24 using different cut-offs, corresponding to the 5th percentile (0.5%-1.2%). 15,16,18,19,24 In the study by Granelli and Östman-Smith, 15 in a pre-selected group of newborns with LHOD, 5 out of 9 newborns had either pre-or post-ductal PI values <0.7%, when screened at between 19 and 120 h after birth. Schena et al and Uygur et al 18,19 screened a healthy population of newborns with POS and PI at 48-72 and 24-48 h of age, respectively.…”

“…12,13 PI as a screening tool has raised some hope in increasing neonatal detection of CoA and other LHOD, [14][15][16][17][18][19] with reported sensitivities for CoA varying between 33% and 100% depending on the cut-offs used. 15,16,18 However, existing data do not yet support inclusion of PI to neonatal CCHD-screening, the high false-positive rate is one concern. 20,21 We hypothesised that the false-positive rate of PI can be reduced by repeating the measurement if below cut-off.…”

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

“…2,3 LHOD are likely to reduce systemic circulation, and the fact that modern pulse oximeters can now record perfusion index (PI; an assessment of the strength of the peripheral pulse) at the same time as measuring oxygen saturations has led researchers to investigate the potential role of PI as an additional screening tool for these specific defects. [6][7][8][9][10][11] These studies have attempted to investigate two important parameters -i) the normal range of PI in healthy newborn babies and ii) the threshold below which PI becomes an accurate and useful screening test for CCHD, particularly LHOD. Both have proven to be quite inconsistent.…”