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Low false-positive rate of perfusion index as a screening tool for neonatal aortic coarctation
Katarina Lannering1,2, Anders Elfvin1,3, Mats Mellander1,2
1Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Repeated perfusion index (PI) measurements significantly reduced false positives in neonatal screening for coarctation of the aorta (CoA). This improved accuracy enhances early detection of critical congenital heart defects.
Area of Science:
- Neonatal cardiology
- Medical device technology
- Screening protocols
Background:
- Pulse oximetry screening (POS) can be enhanced by adding perfusion index (PI) for detecting coarctation of the aorta (CoA).
- A previously suggested PI cut-off of <0.7% resulted in a high rate of false positives, limiting its clinical utility.
Purpose of the Study:
- To evaluate the specificity of perfusion index (PI) in neonatal screening for coarctation of the aorta (CoA).
- To determine if repeated PI measurements can reduce the false-positive rate compared to single measurements.
Main Methods:
- A pilot study initially involved 50 neonates, with PI measured in the hand and foot. Measurements were repeated up to three times if the initial PI was <0.7%.
- A modified protocol with 30-minute intervals between repeated measurements was used for an additional 463 neonates.
- Echocardiography was performed on neonates with positive screens.
Main Results:
- The initial pilot study showed 3/50 false-positive screens with immediate repeated measurements.
- In the larger cohort using the modified protocol, there were no false positives.
- The only neonate diagnosed with CoA had a negative screening result (PI hand 1.2%, foot 0.8%).
Conclusions:
- Repeated perfusion index measurements effectively reduce the false-positive rate in neonatal screening for coarctation of the aorta.
- Further large-scale prospective studies are necessary to evaluate the sensitivity of this modified PI screening protocol for CoA detection.
Aim:
Adding perfusion index (PI) to pulse oximetry screening (POS) may increase neonatal detection of CoA (aortic coarctation). A cut-off <0.7% has been suggested but is associated with a high rate of false positives. We aimed to evaluate the specificity of PI when using repeated instead of single measurements.
Methods:
A pilot study was conducted in 50 neonates. PI was recorded in right hand and a foot by pulse oximeter. If PI was <0.7%, the measurement was immediately repeated up to 3 times. If all three measurements were <0.7% in hand and/or foot the screen was positive and echocardiography was performed. There were 3/50 false-positive screens. The protocol was therefore modified requiring 30 min intervals between measurements.
Results:
An additional 463 neonates were included using the modified protocol at a median age of 18 h. There were no false positives. The only neonate with CoA had a negative screen (PI hand 1.2% and foot 0.8%). The measurement required on average an extra 3 min and 30 s compared with POS only.
Conclusion:
The false-positive rate of PI was reduced by using repeated PI measurements. The sensitivity for CoA using this protocol should be evaluated in large-scale prospective studies.
