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Correlation between Perfusion Index and Left Ventricular Output in Healthy Late Preterm InfantsFunding None.
Aim The perfusion index (PI) is a noninvasive marker derived from photoelectric plethysmographic signals in pulse oximetry in the evaluation of peripheral perfusion. This study was aimed to determine the correlation between PI and left ventricular output (LVO) in healthy late preterm infants at 48th hour of life.
Methods With new generation pulse oximeter (MASIMO Rad 7 Oximeter) pre- and post-ductal PI values were recorded from healthy late preterm babies at the 48th hour of life. PI was determined simultaneously with LVO as measured by transthoracic echocardiography.
Results A total of 50 late preterm babies were included in the study. The mean gestational age of the cases was 35.4 ± 0.7 weeks and the birth weight was 2,586 ± 362 g. Mean pre- and post-ductal PI values at the postnatal 48th hour of babies' life were found to be 2.0 ± 0.9 and 1.7 ± 1.1. The mean LVO value was 438 ± 124, LVO/kg 175 ± 50. When the LVO value was normalized according to the babies' body weight, there was no statistically significant correlation between the pre- and post-ductal PI and the LVO/kg value (r <0.2, p >0.05 in both comparisons).
Conclusion There was no correlation between pre- and post-ductal PI and LVO values in healthy late preterm infants. This may be due to the failure of the LVO, a systemic hemodynamic parameter, to accurately reflect microvascular blood flow due to incomplete maturation of the sympathetic nervous system involved in the regulation of peripheral tissue perfusion in preterm babies.
No correlation found between PI and LOV in preterm babies.
LVO cannot adequately reflect peripheral blood flow.
Sympathetic nervous system is immature in preterm infants.
N.H. and H.O. contributed toward concept of the study. N.H. and A.A. designed the study. M.A. and H.O. did the supervision. Ö.İ. and A.A. collected the materials. A.A., Ö.İ., and H.O. did the data collection and/or processing. A.A., Ö.İ., and M.A. did the literature review. A.A., N.H., and Ö.İ wrote the manuscript. H.O. did the echocardiographic evaluation. and N.H., M.A., and H.O. did the critical review.
The study was approved by our faculty of ethics committee (date: May 02, 2019 and decision no: 08/II).
Consent to Participate
Formal and written consents were obtained from the study subjects' parent.
Consent for Publication
All authors would like to publish their manuscript in American Journal of Perinatology.
* Both authors contributed equally to the article.
Received: 24 May 2021
Accepted: 27 July 2021
20 September 2021 (online)
© 2021. Thieme. All rights reserved.
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- 1 Frank LH, Bradshaw E, Beekman R, Mahle WT, Martin GR. Critical congenital heart disease screening using pulse oximetry. J Pediatr 2013; 162 (03) 445-453
- 2 Kemper AR, Mahle WT, Martin GR. et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128 (05) e1259-e1267
- 3 Mahle WT, Martin GR, Beekman III RH, Morrow WR. Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics 2012; 129 (01) 190-192
- 4 Mellander M, Sunnegårdh J. Failure to diagnose critical heart malformations in newborns before discharge—an increasing problem?. Acta Paediatr 2006; 95 (04) 407-413
- 5 Granelli Ad, Ostman-Smith I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr 2007; 96 (10) 1455-1459
- 6 Riede FT, Wörner C, Dähnert I, Möckel A, Kostelka M, Schneider P. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine—results from a prospective multicenter study. Eur J Pediatr 2010; 169 (08) 975-981
- 7 Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med 2005; 31 (10) 1316-1326
- 8 Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002; 30 (06) 1210-1213
- 9 Piasek CZ, Van Bel F, Sola A. Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. Acta Paediatr 2014; 103 (05) 468-473
- 10 Corsini I, Cecchi A, Coviello C, Dani C. Perfusion index and left ventricular output correlation in healthy term infants. Eur J Pediatr 2017; 176 (08) 1013-1018
- 11 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (01) 92-100
- 12 Mertens L, Seri I, Marek J. et al; Writing Group of the American Society of Echocardiography (ASE), European Association of Echocardiography (EAE), Association for European Pediatric Cardiologists (AEPC). Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 2011; 12 (10) 715-736
- 13 van Vonderen JJ, te Pas AB, Kolster-Bijdevaate C. et al. Non-invasive measurements of ductus arteriosus flow directly after birth. Arch Dis Child Fetal Neonatal Ed 2014; 99 (05) F408-F412
- 14 Kluckow M, Evans N. Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 2000; 82 (03) F182-F187
- 15 De Felice C, Latini G, Vacca P, Kopotic RJ. The pulse oximeter perfusion index as a predictor for high illness severity in neonates. Eur J Pediatr 2002; 161 (10) 561-562
- 16 Zaramella P, Freato F, Quaresima V. et al. Foot pulse oximeter perfusion index correlates with calf muscle perfusion measured by near-infrared spectroscopy in healthy neonates. J Perinatol 2005; 25 (06) 417-422
- 17 Unal S, Ergenekon E, Aktas S. et al. Perfusion index assessment during transition period of newborns: an observational study. BMC Pediatr 2016; 16 (01) 164
- 18 Hakan N, Dilli D, Zenciroglu A, Aydin M, Okumus N. Reference values of perfusion indices in hemodynamically stable newborns during the early neonatal period. Eur J Pediatr 2014; 173 (05) 597-602
- 19 Cresi F, Pelle E, Calabrese R, Costa L, Farinasso D, Silvestro L. Perfusion index variations in clinically and hemodynamically stable preterm newborns in the first week of life. Ital J Pediatr 2010; 36: 6
- 20 Evans N. Assessment and support of the preterm circulation. Early Hum Dev 2006; 82 (12) 803-810
- 21 Takahashi S, Kakiuchi S, Nanba Y, Tsukamoto K, Nakamura T, Ito Y. The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants. J Perinatol 2010; 30 (04) 265-269
- 22 Sahni R, Schulze KF, Ohira-Kist K, Kashyap S, Myers MM, Fifer WP. Interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infants. Acta Paediatr 2010; 99 (01) 135-139
- 23 Hales JR, Stephens FR, Fawcett AA. et al. Observations on a new non-invasive monitor of skin blood flow. Clin Exp Pharmacol Physiol 1989; 16 (05) 403-415