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

Perfusion index cannot be currently recommended as an additional newborn screen for critical congenital heart disease: more data needed

“…However, as described in this recent Archimedes article,5 POS is not a perfect test. Some babies (particularly those with defects that obstruct left ventricular outflow such as coarctation of the aorta [CoA] and interrupted aortic arch [IAA]) are missed by POS and other routine screening tests4 and Searle and colleagues quite rightly ask if an additional screening tool—perfusion index (PI)—could have identified such defects earlier 5…”

“…Although the premise for considering the use of PI in this context is logical and appealing, this review demonstrates inherent concerns which mean that the case for considering PI as an additional screening test for CCHD is not yet proven 5…”

“…As Searle et al describe, PI is an assessment of pulse strength—measured at the same time as oxygen saturations by a pulse oximeter which calculates the ratio of pulsatile to non-pulsatile blood. Lower PI values represent reduced perfusion 5…”

Oxygen Saturation and Perfusion Index-Based Enhanced Critical Congenital Heart Disease Screening

“…19,20 Peripheral perfusion index (PIx), a noninvasive measurement of pulsatile blood flow independent of oxygenation that can be measured simultaneously with SpO 2 , may enhance the detection of CCHD, particularly defects such as CoA and IAA. [21][22][23] However, the limited available literature does not provide consensus regarding normal PIx values and those indicative of CCHD. [21][22][23] Additionally, current literature mostly includes PIx measurements in normal newborns and neonates with acyanotic systemic obstruction defects, and therefore we do not know if PIx may be abnormal in newborns with non-CCHD or cyanotic defects.…”

“…[21][22][23] However, the limited available literature does not provide consensus regarding normal PIx values and those indicative of CCHD. [21][22][23] Additionally, current literature mostly includes PIx measurements in normal newborns and neonates with acyanotic systemic obstruction defects, and therefore we do not know if PIx may be abnormal in newborns with non-CCHD or cyanotic defects. We conducted a cohort study assessing PIx among newborns with and without CHD.…”