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Published in: European Journal of Pediatrics 8/2017

01-08-2017 | Original Article

Perfusion index and left ventricular output correlation in healthy term infants

Authors: Iuri Corsini, Alessandra Cecchi, Caterina Coviello, Carlo Dani

Published in: European Journal of Pediatrics | Issue 8/2017

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Abstract

Perfusion index (PI) is a non-invasive marker of peripheral perfusion which is detected by an oximeter. We aimed to assess the correlation between PI and left ventricular output (LVO) in healthy term infants at the time of the screening for congenital heart disease (CHD). PI was measured at 48±2 h of life in the infant’s right hand (PIrh) and in one foot (PIf) contemporary to SpO2 for CHD screening. Heart ultrasound was performed immediately after the screening procedure for measuring LVO. Forty-nine healthy term infants were studied. PIrh and PIf were 1.9 ± 0.6 and 1.9 ± 0.8, respectively, and their values were significantly correlated (p < 0.0001) with a coefficient r = 0.8. Bland–Altman analysis shows a mean difference of −0.06 ± 0.47 (95%LOA −0.98–0.86). PIrh correlates with LVO (r = 0.68) and LVO/kg (r = 0.61) with an increase of 151 mL/min (95%CI 103–198) of LVO and 42 mL/kg/min (95%CI 26–58) of LVO/kg per point of PIrh. PIf correlates with LVO (r = 0.74) and LVO/kg (r = 0.73) with an increase of 123 mL/min (95%CI 90–155) of LVO and 37 mL/kg/min (95%CI 27–47) of LVO/kg per point of PIf.
Conclusion: PI is significantly correlated with LVO in healthy term infants. These results support the theoretical potential role of PI in the CHD screening.
What is Known:
• Perfusion index is an indirect measure of perfusion which depends on cardiac output and peripheral vascular resistance whose normal values have been documented in term and preterm infants in the first days of life.
• Perfusion index has been proposed for the screening of congenital heart disease with duct-dependent systemic circulation in term infants.
What is New:
• Perfusion index shows a significant correlation with the left ventricular output in term infants at the moment of the screening for congenital heart disease.
• Perfusion index might have a theoretical role in improving the accuracy of pulse oximetry in the screening of CHD associated to low systemic flow.
Literature
1.
go back to reference Cresi F, Pelle E, Calabrese R, Costa L, Farinasso D, Silvestro L (2010) Perfusion index variations in clinically and hemodynamically stable preterm newborns in the first week of life. Ital J Pediatr 36:6. doi:10.1186/1824-7288-36-6 Cresi F, Pelle E, Calabrese R, Costa L, Farinasso D, Silvestro L (2010) Perfusion index variations in clinically and hemodynamically stable preterm newborns in the first week of life. Ital J Pediatr 36:6. doi:10.​1186/​1824-7288-36-6
3.
go back to reference Fixler DE, Xu P, Nembhard WN, Ethen MK, Canfield MA (2014) Age at referral and mortality from critical congenital heart disease. Pediatrics 134:e98–e105CrossRefPubMed Fixler DE, Xu P, Nembhard WN, Ethen MK, Canfield MA (2014) Age at referral and mortality from critical congenital heart disease. Pediatrics 134:e98–e105CrossRefPubMed
4.
go back to reference Granelli AD, Östman-Smith I (2007) Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr 96:1455–1459CrossRefPubMed Granelli AD, Östman-Smith I (2007) Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr 96:1455–1459CrossRefPubMed
5.
go back to reference Granelli AD, Wennergren M, Sandberg K, Mellander M, Bejlum C, Inganas L, Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunnegardh J, Verdicchio M, Ostman-Smith I (2009) Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns. BMJ 338:a3037CrossRef Granelli AD, Wennergren M, Sandberg K, Mellander M, Bejlum C, Inganas L, Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunnegardh J, Verdicchio M, Ostman-Smith I (2009) Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns. BMJ 338:a3037CrossRef
6.
go back to reference Groves AM, Chiesa G, Durighel G, Goldring ST, Fitzpatrick JA, Uribe S, Razavi R, Hajnal JV, Edwards AD (2011) Functional cardiac MRI in preterm and term newborns. Arch Dis Child Fetale and Neonatal Ed 96:86–91. doi:10.1136/adc.2010.189142 Groves AM, Chiesa G, Durighel G, Goldring ST, Fitzpatrick JA, Uribe S, Razavi R, Hajnal JV, Edwards AD (2011) Functional cardiac MRI in preterm and term newborns. Arch Dis Child Fetale and Neonatal Ed 96:86–91. doi:10.​1136/​adc.​2010.​189142
7.
go back to reference Hoffman JIE, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900CrossRefPubMed Hoffman JIE, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900CrossRefPubMed
8.
go back to reference Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson GD, Glidewell J, Grosse SD, Howell RR et al (2011) Strategies for implementing screening for critical congenital heart disease. Pediatrics 128:e1259–e1267CrossRefPubMed Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson GD, Glidewell J, Grosse SD, Howell RR et al (2011) Strategies for implementing screening for critical congenital heart disease. Pediatrics 128:e1259–e1267CrossRefPubMed
9.
go back to reference Kluckow M, Evans N (2000) Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 82:F182–F187CrossRefPubMedPubMedCentral Kluckow M, Evans N (2000) Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 82:F182–F187CrossRefPubMedPubMedCentral
10.
go back to reference Kroese JK, van Vonderen JJ, Narayen IC, Walther FJ, Hooper S, Te Pas AB (2015) The perfusion index of healthy term infants during transition at birth. Eur J Pediatr 175(4):475–479CrossRefPubMedPubMedCentral Kroese JK, van Vonderen JJ, Narayen IC, Walther FJ, Hooper S, Te Pas AB (2015) The perfusion index of healthy term infants during transition at birth. Eur J Pediatr 175(4):475–479CrossRefPubMedPubMedCentral
11.
go back to reference Mellander M, Sunnegårdh J (2006) Failure to diagnose critical heart malformations in newborns before discharge—an increasing problem? Acta Paediatr 95:407–413CrossRefPubMed Mellander M, Sunnegårdh J (2006) Failure to diagnose critical heart malformations in newborns before discharge—an increasing problem? Acta Paediatr 95:407–413CrossRefPubMed
12.
go back to reference Mertens L, Seri I, Marek J, Arlettaz R, Braker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW, Writing group of the American Society of Echocardiography (ASE), European Association of Echocardiography (EAE), Association for European Pediatric Cardiologists (AEPC) (2011) Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 12:715–736CrossRefPubMed Mertens L, Seri I, Marek J, Arlettaz R, Braker P, McNamara P, Moon-Grady AJ, Coon PD, Noori S, Simpson J, Lai WW, Writing group of the American Society of Echocardiography (ASE), European Association of Echocardiography (EAE), Association for European Pediatric Cardiologists (AEPC) (2011) Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 12:715–736CrossRefPubMed
13.
go back to reference Patel N, Dodsworth M, Mills JF (2011) Cardiac output measurement in newborn infants using the ultrasonic cardiac output monitor: an assessment of agreement with conventional echocardiography, repeatability and new user experience. Arch Dis Child - Fetal Neonatal Ed 96:F206–F211. doi:10.1136/adc.2009.170704 Patel N, Dodsworth M, Mills JF (2011) Cardiac output measurement in newborn infants using the ultrasonic cardiac output monitor: an assessment of agreement with conventional echocardiography, repeatability and new user experience. Arch Dis Child - Fetal Neonatal Ed 96:F206–F211. doi:10.​1136/​adc.​2009.​170704
14.
go back to reference Piasek CZ, Van Bel F, Sola A (2014) Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. Acta Paediatr 103:468–473CrossRefPubMed Piasek CZ, Van Bel F, Sola A (2014) Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. Acta Paediatr 103:468–473CrossRefPubMed
15.
go back to reference Singh A, Rasiah SV, Ewer AK (2014) The impact of routine predischarge pulse oximetry screening in a regional neonatal unit. Arch Dis Child Fetal Neonatal Ed 99(4):F297–F302CrossRefPubMed Singh A, Rasiah SV, Ewer AK (2014) The impact of routine predischarge pulse oximetry screening in a regional neonatal unit. Arch Dis Child Fetal Neonatal Ed 99(4):F297–F302CrossRefPubMed
16.
17.
go back to reference Takahashi S, Kakiuchi S, Nanba Y, Tsukamoto K, Nakamura T, Ito Y (2010) The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants. J Perinatol 30:265–269CrossRefPubMed Takahashi S, Kakiuchi S, Nanba Y, Tsukamoto K, Nakamura T, Ito Y (2010) The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants. J Perinatol 30:265–269CrossRefPubMed
18.
go back to reference Thangaratinam S, Brown K, Zamora J, et al (2012) Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: A systematic review and metaanalysis. Lancet. doi:10.1016/S0140-6736(12)60107-X Thangaratinam S, Brown K, Zamora J, et al (2012) Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: A systematic review and metaanalysis. Lancet. doi:10.​1016/​S0140-6736(12)60107-X
19.
go back to reference Vidal M, Ferragu F, Durand S, Baleine J, Batista-Novais AR, Cambonie G (2013) Perfusion index and its dynamic changes in preterm neonates with patent ductus arteriosus. Acta Paediatr 102:373–378CrossRefPubMed Vidal M, Ferragu F, Durand S, Baleine J, Batista-Novais AR, Cambonie G (2013) Perfusion index and its dynamic changes in preterm neonates with patent ductus arteriosus. Acta Paediatr 102:373–378CrossRefPubMed
20.
go back to reference van Vonderen JJ, Pas te AB, Kolster-Bijdevaate C, van Lith JM, Blom NA, Hooper SB, Roest AA (2014) Non-invasive measurements of ductus arteriosus flow directly after birth. Arch Dis Child Fetal Neonatal Ed 99:F408–F412CrossRefPubMed van Vonderen JJ, Pas te AB, Kolster-Bijdevaate C, van Lith JM, Blom NA, Hooper SB, Roest AA (2014) Non-invasive measurements of ductus arteriosus flow directly after birth. Arch Dis Child Fetal Neonatal Ed 99:F408–F412CrossRefPubMed
Metadata
Title
Perfusion index and left ventricular output correlation in healthy term infants
Authors
Iuri Corsini
Alessandra Cecchi
Caterina Coviello
Carlo Dani
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 8/2017
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-017-2920-1

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