Department of Pediatrics, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California.
Division of Neonatology, Rady Children's Hospital, San Diego, California.
Am J Perinatol. 2024 May;41(S 01):e545-e549. doi: 10.1055/a-1904-9389. Epub 2022 Jul 20.
This study aimed to compare oximetry data (pre- and postductal oxygen saturation [SpO], pre- and postductal pulsatility index [PI]) in healthy newborns (≥35 weeks' gestational age) to infants who have critical congenital heart disease (CCHD).
This is a retrospective analysis of data obtained from electronic medical records, recorded as part of routine pulse oximetry screening (POS) for CCHD in infants born between the years 2013 and 2020. Testing was performed at 24 ± 2 hours of life. Data were analyzed to detect differences in pre- and postductal SpO and pre- and postductal PI in healthy newborns compared with infants who have CCHD. Newborns were excluded from analysis if they: (1) had a prenatal diagnosis of CCHD in the medical record, (2) had previously been admitted to the neonatal intensive care unit, or (3) had failed POS but were found no CCHD by diagnostic echocardiography.
A total of 88,754 healthy newborns had received POS between the years 2013 and 2020. Of the 88,736 newborn records available for analysis,18 newborns were diagnosed with CCHD. Eight were identified by POS before discharge and 10 were diagnosed after discharge. Infants diagnosed with CCHD by POS had lower pre- and postductal SpO compared with normal infants. Their postductal PI was significantly lower. Infants who had CCHD that was not identified by POS had similar pre- and postductal SpO values, but their postductal PI was lower. Using a postductal PI cutoff of 1.21 had a receiver operating curve of area under the curve 0.77 (95% confidence interval: 0.672, 0.869) with 74% sensitivity and 61% specificity.
In our large cohort of infants born in San Diego County, the postductal PI is lower in infants with CCHD. Given that PI is routinely displayed on every pulse oximeter and the high morbidity of missed CCHD, PI should be incorporated into routine CCHD screening.
· Postductal PI is lower in newborn who presented later with congenital heart disease.. · Postductal PI cut-off of 1.21 may help practitioners determine if a newborn is at risk for CCHD.. · This large cohort study demonstrates that a low PI can detect additional CCHD cases..
本研究旨在比较健康新生儿（胎龄≥35 周）与患有严重先天性心脏病（CCHD）的婴儿的血氧仪数据（导管前和导管后氧饱和度[SpO]、导管前和导管后搏动指数[PI]）。
这是一项对 2013 年至 2020 年期间出生的婴儿进行 CCHD 常规脉搏血氧仪筛查（POS）过程中获得的电子病历数据进行的回顾性分析。测试在出生后 24±2 小时进行。对数据进行分析，以检测健康新生儿与患有 CCHD 的婴儿之间导管前和导管后 SpO 以及导管前和导管后 PI 的差异。如果新生儿有以下情况，则将其从分析中排除：（1）病历中有 CCHD 的产前诊断，（2）曾入住新生儿重症监护病房，或（3）POS 失败，但经诊断性超声心动图检查未发现 CCHD。
2013 年至 2020 年间，共有 88754 名健康新生儿接受了 POS。在可用于分析的 88736 名新生儿记录中，有 18 名新生儿被诊断为 CCHD。其中 8 例在出院前通过 POS 确诊，10 例在出院后确诊。通过 POS 确诊为 CCHD 的婴儿的导管前和导管后 SpO 明显低于正常婴儿。他们的导管后 PI 明显较低。通过 POS 未确诊为 CCHD 的婴儿的导管前和导管后 SpO 值相似，但他们的导管后 PI 较低。使用导管后 PI 截断值 1.21 得到的受试者工作特征曲线下面积为 0.77（95%置信区间：0.672，0.869），灵敏度为 74%，特异性为 61%。
在我们圣地亚哥县的大型婴儿队列中，患有 CCHD 的婴儿的导管后 PI 较低。鉴于 PI 常规显示在每个脉搏血氧仪上，并且错过 CCHD 的发病率很高，因此应将 PI 纳入常规 CCHD 筛查。
· 出现较晚的先天性心脏病患儿的导管后 PI 较低。· 导管后 PI 截断值 1.21 可帮助医生确定新生儿是否存在 CCHD 风险。· 这项大型队列研究表明，低 PI 可检测到更多的 CCHD 病例。
