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. 2021 Jun;110(6):1788-1794.
doi: 10.1111/apa.15661. Epub 2020 Dec 2.

Low false-positive rate of perfusion index as a screening tool for neonatal aortic coarctation

Katarina Lannering  1   2 , Anders Elfvin  1   3 , Mats Mellander  1   2
Affiliations

Low false-positive rate of perfusion index as a screening tool for neonatal aortic coarctation

Katarina Lannering et al. Acta Paediatr. 2021 Jun.

Abstract

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.

Keywords: aortic coarctation; perfusion index; screening.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
The distribution of PI in the right hand (A) and one foot (B)
Figure 2
Figure 2
PI in the right hand (A) and foot (B). Each box‐and whisker plot at 4 h age intervals
Figure 3
Figure 3
The distribution of the difference of PI between the right hand and one foot
Figure 4
Figure 4
Bland Altman Plot depicting the difference between manually collected vs trend data on PI. Dark blue line represents the mean and the light blue lines 95% CI (−0.13–0.12)
See this image and copyright information in PMC

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