Objectives To calculate diagnostic values of the femoral pulse palpation to detect coarctation of the aorta or other left-sided obstructive heart anomalies in newborn infants.
Design Population-based cohort study.
Setting Stockholm-Gotland County 2008–2012.
Patients All singleton live-born infants without chromosomal trisomies, at ≥35 gestational weeks, followed-up until 1–2 years of age.
Main outcome measures Diagnostic values and ORs for the femoral pulse test and subsequent diagnosis of coarctation of the aorta or left-sided obstructive heart malformation.
Results Among the 118 592 included infants, 432 had weak or absent femoral pulses at the newborn examination. Seventy-eight infants were diagnosed with coarcation of the aorta and 48 with other left-sided obstructive heart malformations. The diagnostic values for the femoral pulse palpation test to detect coarctation of the aorta were: sensitivity: 19.2%, specificity: 99.6, positive predictive value: 3.5% and negative predictive value: 99.9%. For left-sided heart malformations: sensitivity: 8.3%, specificity: 99.6%, positive predictive value: 0.9% and negative predictive value: 100%. Sensitivity for coarctation of the aorta increased from 16.7% when examined at <12 hours of age to 30.0% at ≥96 hours of age.
Conclusions The femoral pulse test to detect coarctation of the aorta and left-sided heart malformations has limited sensitivity, whereas specificity is high. As many infants with life-threatening cardiac malformations leave the maternity ward undiagnosed, further efforts are necessary to improve the diagnostic yield of the routine newborn examination.
- coarctation of the aorta
- congenital malformations
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Contributors FKN, MA, SJ and OS designed the study. GP programmed the dataset. FKN and MA analysed the data. FKN performed the literature search and wrote the first draft of the manuscript. SJ, OS, GP and MA redrafted the manuscript. MA was the guarantor of the study, was responsible for the work and controlled the decision to publish. All authors approved the final manuscript before submission.
Funding FKN was supported by the Foundation of Samaritan, the Freemasons Foundations House of Children and the Foundation of Sven Jerring. MA was supported by the Stockholm City Council. OS was supported by the Swedish Research Council (523-2013-2429), the Swedish Research Council for Health, Working Life and Welfare (2015-00251), Stockholm City Council and the Strategic Research Program in Epidemiology at Karolinska Institutet. All authors are independent from their funding sources and all had full access to the data and take full responsibility for the integrity of the data and the accuracy of the data analysis.
Disclaimer None of the funding sources had any role in the study design, collection, analysis or interpretation of data, nor in the writing of the manuscript or the decision to submit for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Approval was obtained from the Regional Ethical Review Board in Stockholm (reference numbers 2009/275-31 and 2014/177-32).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request, after a renewed ethics approval.