Article Text

Download PDFPDF
Perfusion index cannot be currently recommended as an additional newborn screen for critical congenital heart disease: more data needed
  1. Andrew K Ewer1,2
  1. 1 Neonatal Unit, Birmingham Womens Hospital, Birmingham, UK
  2. 2 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Andrew K Ewer, Department of Neonatal Unit, Birmingham Womens Hospital, Birmingham B15 2TG, UK; a.k.ewer{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Routine pulse oximetry screening (POS) of newborn babies before discharge from hospital has been shown to identifying cases of critical congenital heart disease (CCHD) with consistent test accuracy1 and to reduce mortality from these conditions by one-third.2

There is increasing uptake of POS in high-income and middle-income countries1–4; in July 2018, after several years of state-by-state introduction, POS became mandatory across the USA2 which means that almost 4 million babies a year will undergo the test in that country alone.

POS reduces the ‘diagnostic gap’ for CCHD, that is, it identifies additional cases which are missed by other screening methods such as antenatal ultrasound and postnatal examination.1 The size of this gap varies depending on local circumstances, but the addition of POS consistently reduces it to less than 10%.4

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

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

Given that critical obstruction …

View Full Text


  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AKE has received travel and accommodation expenses from Masimo and Medtronic to present at scientific meetings only and has received no personal payments or honoraria from any oximeter manufacturers.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not requried.

Linked Articles