Perfusion Index and Pulse Oximetry Screening for Congenital Heart Defects

Area of Science:

• Neonatal screening
• Cardiology
• Public health

Background:

• Severe congenital heart defects (sCHD) are a significant concern in newborns.
• Early detection is crucial for improving outcomes.
• Current screening methods have limitations, particularly in nontertiary settings.

Purpose of the Study:

• To evaluate the efficacy of combined pulse oximetry (POX) and perfusion index (PI) screening for sCHD.
• To assess the impact of this combined screening in tertiary versus nontertiary hospitals.
• To determine the sensitivity, specificity, and predictive values of the screening protocol.

Main Methods:

• A multicenter, prospective study involving 42,169 asymptomatic newborns.
• Exclusion of neonates with antenatal or suspected postnatal sCHD, or NICU admission.
• Pre- and postductal POX and PI measurements were taken before discharge.

Main Results:

• The prevalence of unexpected sCHD was 1 in 1115 live births.
• Combined PI-POX screening identified 3 sCHD cases and missed 4.
• In nontertiary units, PI-POX screening increased the detection rate from 28% to 71%.

Conclusions:

• Combined PI-POX screening offers significant benefits in nontertiary hospitals with lower clinical recognition rates.
• Perfusion index screening aids in identifying coarctation of the aorta cases missed by pulse oximetry alone.
• Further evaluation is needed for populations with higher rates of missed sCHD cases.