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Oxygen Saturation and Perfusion Index-Based Enhanced Critical Congenital Heart Disease Screening
Heather Siefkes1, Laura Kair1, Daniel J Tancredi1
1Department of Pediatrics, University of California, Davis, Sacramento, California.
Insights
Adding perfusion index (PIx) to pulse oximetry (SpO2) screening significantly improves detection of critical congenital heart disease (CCHD) with systemic outflow obstruction in newborns. Further research is needed for optimal screening thresholds.
Area of Science:
- Neonatal screening
- Cardiology
- Medical device technology
Background:
- Critical congenital heart disease (CCHD) poses a significant threat to newborns.
- Current screening methods using oxygen saturation (SpO2) have limitations in detecting certain CCHDs, particularly those with systemic outflow obstruction.
- Perfusion index (PIx), a measure of peripheral circulation, is being explored as a supplementary screening tool.
Purpose of the Study:
- To evaluate if incorporating perfusion index (PIx) into standard oxygen saturation (SpO2) screening enhances the detection rate of critical congenital heart disease (CCHD) characterized by systemic outflow obstruction.
- To establish preliminary screening thresholds for PIx in a neonatal cohort.
- To compare the diagnostic sensitivity of SpO2 screening alone versus combined SpO2 and PIx screening for CCHD with systemic outflow obstruction.
Main Methods:
- A cohort study involving 123 healthy newborns and 21 newborns with congenital heart disease (CHD), including five with critical systemic outflow obstruction.
- Determination of screening thresholds for PIx.
- Application of both SpO2 and PIx screening to all enrolled infants.
- Comparison of detection rates for CCHD with systemic outflow obstruction between SpO2-only screening and combined SpO2-PIx screening.
Main Results:
- SpO2 screening alone detected only 20% of critical systemic obstruction CCHD cases.
- Combined SpO2 and PIx screening demonstrated an increased sensitivity of 80% for detecting systemic obstruction CCHD.
- A small proportion (2.44%) of normal infants failed the PIx screening, indicating a potential for false positives.
Conclusions:
- The addition of PIx to SpO2 screening shows promise for improving the detection of CCHD with systemic outflow obstruction in newborns.
- Further investigation and validation are required to establish optimal PIx screening thresholds to balance sensitivity and specificity.
- PIx may serve as a valuable adjunct to SpO2 in neonatal CCHD screening protocols.
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.
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