Perfusion Index and Pulse Oximetry Screening for Congenital Heart Defects

Federico Schena; Irene Picciolli; Massimo Agosti; Antonio Alberto Zuppa; Gianvincenzo Zuccotti; Luciana Parola; Giulia Pomero; Giorgio Stival; Markus Markart; Silvia Graziani; Luigi Gagliardi; Cristina Bellan; Simona La Placa; Giuseppe Limoli; Gabriella Calzetti; Andrea Guala; Enza Bonello; Fabio Mosca; Neonatal Cardiology Study Group of the Italian Society of Neonatology

doi:10.1016/j.jpeds.2016.12.076

Perfusion Index and Pulse Oximetry Screening for Congenital Heart Defects

J Pediatr. 2017 Apr:183:74-79.e1. doi: 10.1016/j.jpeds.2016.12.076. Epub 2017 Jan 30.

Authors

Federico Schena¹, Irene Picciolli², Massimo Agosti³, Antonio Alberto Zuppa⁴, Gianvincenzo Zuccotti⁵, Luciana Parola⁶, Giulia Pomero⁷, Giorgio Stival⁸, Markus Markart⁹, Silvia Graziani¹⁰, Luigi Gagliardi¹¹, Cristina Bellan¹², Simona La Placa¹³, Giuseppe Limoli¹⁴, Gabriella Calzetti¹⁵, Andrea Guala¹⁶, Enza Bonello¹⁷, Fabio Mosca¹⁸; Neonatal Cardiology Study Group of the Italian Society of Neonatology

Affiliations

¹ Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy. Electronic address: federico.schena@mangiagalli.it.
² Neonatal Intensive Care Unit, Ospedale M. Melloni ASST Fatebenefratelli Sacco, Milan, Italy.
³ Maternal and Child Health Department, Del Ponte Hospital, A.O. Di Circolo Fondazione Macchi, Varese, Italy.
⁴ Department of Neonatology, Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
⁵ Department of Pediatrics, University of Milan, Ospedale dei Bambini V. Buzzi, Milan, Italy.
⁶ Department of Pediatrics and Neonatology, Magenta Hospital AO Ospedale Civile di Legnano, Magenta, Italy.
⁷ Neonatology and Neonatal Intensive Care Unit, ASO St Croce and Carle Hospital, Cuneo, Italy.
⁸ Department of Pediatrics and Neonatology, SS Trinità Hospital Borgomanero, Novara, Italy.
⁹ Department of Pediatrics, Bressanone Hospital, Brixen, Italy.
¹⁰ Department of Neonatology, S. Chiara Hospital, Apss Trento, Italy.
¹¹ Woman and Child Health Department, Pediatric and Neonatology Division, Ospedale della Versilia, Viareggio, Italy.
¹² Department of Neonatology, Bolognini Hospital, Seriate, Bergamo, Italy.
¹³ Department of Sciences for Health Promotion and Mother and Child Care Giuseppe D'Alessandro, University of Palermo, Palermo, Italy.
¹⁴ Department of Pediatrics, Lodi Hospital, Lodi, Italy.
¹⁵ Neonatal Intensive Care Unit, Carlo Poma Hospital, Mantova, Italy.
¹⁶ Departement of Pediatrics, Castelli Hospital, Verbania, Italy.
¹⁷ Neonatal Intensive Care Unit, S Antonio Abate Hospital, Trapani, Italy.
¹⁸ Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy.

PMID: 28153478
DOI: 10.1016/j.jpeds.2016.12.076

Abstract

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 (SpO₂) ≤95%, prepostductal SpO₂ gradient >3%, or PI <0.90. Confirmed positive cases underwent echocardiography for definitive diagnosis. Missed cases were identified by consulting clinical registries at 6 regional pediatric heart centers. Main outcomes were incidence of unexpected sCHD; proportion of undetected sCHD after discharge in tertiary and nontertiary hospitals; and specificity, sensitivity, positive predictive value, and negative predictive value of combined screening.

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 SpO₂, 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.

Keywords: congenital heart defects; neonatal screening; perfusion index; pulse oximetry.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Blood Gas Analysis / methods
Cohort Studies
Heart Defects, Congenital / diagnosis*
Heart Defects, Congenital / epidemiology
Hospitals, Maternity
Humans
Incidence
Infant, Newborn
Intensive Care Units, Neonatal
Italy
Male
Neonatal Screening / methods*
Oximetry / methods*
Oxygen Consumption / physiology
Prospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Tertiary Care Centers