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  • Original Article
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Does measurement of four-limb blood pressures at birth improve detection of aortic arch anomalies?



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).

Study Design:

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 (R2=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.

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This study was funded by 5 R01 HD072929—(SL).

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Correspondence to N Fernandes.

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One of the authors, Dr Lakshminrusimha, was supported by NIH (R01 HD072929) during the study period. This grant reviews optimal oxygen saturation in two-lamb models of neonatal acute lung injury. He is also the alternate principal investigator for the Rochester-Buffalo site for the NICHD neonatal research network. The remaining authors declare no conflicts of interest.

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Patankar, N., Fernandes, N., Kumar, K. et al. Does measurement of four-limb blood pressures at birth improve detection of aortic arch anomalies?. J Perinatol 36, 376–380 (2016).

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