6533b7d0fe1ef96bd125b8f4

RESEARCH PRODUCT

Perfusion Index and Pulse Oximetry Screening for Congenital Heart Defects

Giorgio StivalMarkus MarkartEnza BonelloAndrea GualaSimona La PlacaFederico SchenaIrene PicciolliFabio MoscaCristina BellanLuciana ParolaAntonio Alberto ZuppaGabriella CalzettiSilvia GrazianiGian Vincenzo ZuccottiMassimo AgostiGiuseppe LimoliGiulia PomeroGagliardi Luigi

subject

MalePediatricsNeonatal intensive care unit030204 cardiovascular system & hematologyPediatricsSeverity of Illness IndexHypoplastic left heart syndromeCohort StudiesTertiary Care CentersCongenital0302 clinical medicineNeonatalOximetryProspective StudiesProspective cohort studyHeart Defectsmedicine.diagnostic_testIncidenceIncidence (epidemiology)Perinatology and Child Healthcongenital heart defectsHospitalspulse oximetrycongenital heart defects; neonatal screening; perfusion index; pulse oximetry; Blood Gas Analysis; Cohort Studies; Heart Defects Congenital; Hospitals Maternity; Humans; Incidence; Infant Newborn; Intensive Care Units Neonatal; Italy; Male; Neonatal Screening; Oximetry; Oxygen Consumption; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Tertiary Care Centers; Pediatrics Perinatology and Child HealthIntensive Care UnitsItalymedicine.symptomCohort studyHeart Defects Congenitalmedicine.medical_specialtyMaternityHospitals MaternityRisk AssessmentSensitivity and SpecificityAsymptomatic03 medical and health sciencesNeonatal ScreeningOxygen ConsumptionIntensive Care Units Neonatal030225 pediatricsSeverity of illnessmedicineHumansperfusion indexbusiness.industryInfant NewbornInfantNewbornmedicine.diseasePulse oximetryPediatrics Perinatology and Child HealthBlood Gas Analysisbusiness

description

Objective To evaluate the efficacy of combined pulse oximetry (POX) and perfusion index (PI) neonatal screening for severe congenital heart defects (sCHD) and assess different impacts of screening in tertiary and nontertiary hospitals. Study design A multicenter, prospective study in 10 tertiary and 6 nontertiary maternity hospitals. A total of 42 169 asymptomatic newborns from among 50 244 neonates were screened; exclusion criteria were antenatal sCHD diagnosis, postnatal clinically suspected sCHD, and neonatal intensive care unit admission. Eligible infants underwent pre- and postductal POX and PI screening after routine discharge examination. Targeted sCHD were anatomically defined. Positivity was defined as postductal oxygen saturation (SpO 2 ) ≤95%, prepostductal SpO 2 gradient >3%, or PI Results One hundred forty-two sCHD were detected prenatally. Prevalence of unexpected sCHD was 1 in 1115 live births, similar in tertiary and nontertiary hospitals. Screening identified 3 sCHD (low SpO 2 , 2; coarctation for low PI, 1). Four cases were missed. In tertiary hospitals, 95% of unsuspected sCHDs were identified clinically, whereas only 28% in nontertiary units; in nontertiary units PI-POX screening increased the detection rate to 71%. Conclusions PI-POX predischarge screening provided benefits in nontertiary units, where clinical recognition rate was low. PI can help identify coarctation cases missed by POX but requires further evaluation in populations with higher rates of missed cases.

yearjournalcountryeditionlanguage
2017-04-01The Journal of Pediatrics
https://doi.org/10.1016/j.jpeds.2016.12.076