Screening for Congenital Heart Diseases by Peripheral Perfusion Index in Term Neonates: A Cross-Sectional Study in a Tertiary Care Hospital in South India

Background and Objective: Screening tools are critical for detecting congenital heart diseases (CHDs) among newborns. Peripheral perfusion index (PPI), in addition to pulse oximeter screening, would increase the sensitivity for detecting critical CHDs. The study aimed to determine if the addition of PPI to combined screening (clinical and SpO2 screening with pulse oximetry [POX]) improves the detection of CHDs in term newborns. Methods: In this cross-sectional observational study, a total of 1100 full-term newborns between 24 and 72 h of life were screened for detecting CHD at in the postnatal ward and neonatal intensive care unit at JSS Hospital, Mysore. Clinical examination and POX were performed using new-generation pulse oximeter to record functional hemoglobin saturation (SpO2) as per the American Academy of Paediatrics guidelines. PPI reading was also obtained from the pulse oximeter, and PPI <0.7 was considered screen positive. Results: Out of 1100 term newborns, 554 (50.4%) were male, and the mean birth weight was 2.95 kg (standard deviation: 0.4 kg). Thirty (2.73%) newborns were confirmed as having CHD with Echo-cardiography. The sensitivity and specificity of clinical examination alone were 13.3% and 100%, respectively. The sensitivity and specificity of clinical examination and SpO2 were 36.7% and 96.2%, respectively. Combined screening with clinical examination, POX screening, and <0.7 perfusion index (PI) has the highest sensitivity (36.7%) and 98.3% of specificity. Conclusion: Clinical examination, POX screening as per American Academy of Pediatrics guidelines, and PI <0.7 together have high specificity and sensitivity to rule out CHDs in newborn babies.