Does pulsatility index add value to newborn pulse oximetry screening for critical congenital heart disease?

Abstract

A term neonate collapsed at home on day 5 of life, following a normal pregnancy and delivery. He was poorly perfused and mottled, with impalpable femoral pulses and severe acidosis. Echocardiography demonstrated a closed ductus arteriosus with severe coarctation of the aorta. His routine newborn check and pulse oximetry screening had been normal. Could an additional screening tool have identified the diagnosis earlier and prevented this collapse? Does pulsatility index (perfusion index, PI) provide additional benefit in identifying critical congenital heart disease (cCHD) over standard newborn screening and pulse oximetry, among term neonates before discharge home? A systematic review was performed using PubMed. The following search criteria were applied, without date or language restrictions, on 1 June 2018. ((((Cardiac) OR Heart)) AND ((((Newborn) OR Newborns) OR Neonate) OR Neonates)) AND ((Perfusion index) OR Pulsatility index) Three hundred and twenty articles were identified. The articles were independently screened by two authors (DDT and JS), identifying four relevant papers. References and citations were screened, identifying one further article. ### Commentary cCHD is defined as a cardiac pathology requiring intervention within 28 days of birth and accounts for 15% of all congenital heart diseases.1–3 Despite considerable regional variations, approximately 50% of cCHD cases are highlighted by the fetal anomaly screening programme.4 5 Following routine newborn examination, an estimated 25% are still undiagnosed at discharge home.1 6 …