Does measurement of four-limb blood pressures at birth improve detection of aortic arch anomalies?

Abstract

Objective To determine normal four-extremity blood pressure (BP) in the NICU at birth and the utility of upper (UE) and lower extremity (LE) BP difference to screen for coarctation of aorta (Co-A) and interrupted aortic arch (IAA). Study Design Retrospective study of BP at birth (n=866), and case-control study of Co-A/IAA infants and matched controls (1:2). Results Although BP increased with gestational age (R2=0.3, p<0.0001), the pressure gradient between UE and LE did not change with gestation (p=0.68). Forty-six cases of Co-A/IAA were identified, with 92 controls. Pressure gradient was significantly higher in patients with Co-A/IAA (7.6±14.8 vs.0.4±10mmHg, p=0.004). However, there was overlap between cases and controls resulting in low sensitivity (41.3% with ≥10mmHg gradient cut-off). Conclusion Evaluation of UE-LE BP gradient at birth is a poor screening test for Co-A/IAA with low sensitivity. Repeating four-limb BP after ductal closure at 24–48h along with SpO2 screening for critical congenital heart disease may increase sensitivity.

Consistency of the continuous flow pressure gradient despite aortic arch anomalies co-existing with coarctation

“…The current results should be interpreted relative to several limitations. For example, literature suggests the arm-leg gradient may not be a strong predictor of invasive gradient in CoA patients 1,30 .…”

“…The current results should be interpreted relative to several limitations. For example, literature suggests the arm-leg gradient may not be a strong predictor of invasive gradient in CoA patients 1,30 . Therefore, we expect the CFPG cutoffs obtained here may be different if sphygmomanometry data are compared to gold-standard catheterization data, which were not available for the cohort of pediatric CoA patients studied.…”

Fifteen-minute consultation: Cardiac murmurs in the Newborn Infant Physical Examination (NIPE)

“…Patankar et al 14 reviewed this in a two-part study with a retrospective analysis of 866 infants admitted to neonatal intensive care unit who underwent four-limb BPs and a case–control study of 46 infants with coarctation/interrupted aortic arch vs 92 controls. Their data confirm a statistically significant difference in upper versus lower limb BP in babies with arch anomalies.…”

Early Detection by Point of Care Ultrasound of Congenital Heart Disease in Critically ill Neonates: A Case Report

“…[11] In the evaluation measuring blood pressure in the upper and lower extremities is necessary because low systolic blood pressure of the lower extremity to the upper should raise suspicion of Certification of the aorta. [12] Transthoracic echocardiography is initially the diagnostic tool for the coarctation of the aorta. [13] The suprasternal aortic arch view can reveal aortic coarctation, particularly when combined with color flow mapping.…”