title: Does measurement of four-limb blood pressures at birth improve detection of aortic arch anomalies?
abstract: To determine normal four-extremity blood pressure (BP) in the neonatal intensive care unit (NICU) at birth and the utility of upper (UE) and lower extremity (LE) BP difference to screen for coarctation of the aorta (Co-A) and interrupted the aortic arch (IAA).
  
  
  
  Retrospective study of BP at birth (n=866), and case-control study of Co-A/IAA infants and matched controls (1:2).
  
  
  
  Although BP increased with gestational age (R(2)=0.3, P<0.0001), the pressure gradient between UE and LE did not change with gestation (P=0.68). Forty-six cases of Co-A/IAA were identified, with 92 controls. Pressure gradient was significantly higher in patients with Co-A/IAA (7.6±14.8 versus 0.4±10 mm Hg, P=0.004). However, there was overlap between cases and controls resulting in low sensitivity (41.3% with ⩾10 mm Hg gradient cutoff).
  
  
  
  Evaluation of UE-LE BP gradient at birth is a poor screening test for Co-A/IAA with low sensitivity. Repeating four-limb BP after ductal closure at 24 to 48 h along with SpO2 screening for critical congenital heart disease may increase sensitivity.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, Buffalo, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Patankar
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, Buffalo, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Fernandes
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, Buffalo, NY, USA.
authors.forename: K
authors.identifier: 0000-0003-0145-682X
authors.initials: K
authors.lastname: Kumar
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center, University at Buffalo, Buffalo, NY, USA.
authors.forename: V
authors.initials: V
authors.lastname: Manja
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, Buffalo, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Lakshminrusimha
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities*; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods*; D018376:Cardiovascular Abnormalities / Q000175:diagnosis / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D015997:Neonatal Screening; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States; D034941:Upper Extremity / Q000098:blood supply