The purpose of this study is to obtain the reference range of peripheral perfusion index (PPI) of asymptomatic well newborns at 6 to 72 h of life at different altitudes. A population-based prospective cohort study was conducted in cities at different altitudes in China. Asymptomatic well newborns were enrolled consecutively from six hospitals with an altitude of 4 to 4200 m between February 1, 2020, and April 15, 2021. PPI was measured at 6, 12, 24, 48, and 72 h after birth on the right hand (pre-ductal) and either foot (post-ductal) using a Masimo SET Radical-7 oximeter. Fiftieth percentile reference curves of the pre- and post-ductal PPI values at 6–72 h after birth were generated using the Lambda Mu Sigma method. Linear mixed-effects regression was performed to determine the influence of different altitude levels on PPI values over different measurement time points. A total of 4257 asymptomatic well newborns were recruited for analysis. The median and quartile pre- and post-ductal PPI values at 6–72 h of life at different altitudes were 1.70 (1.20, 2.60) and 1.70 (1.10, 2.70) for all infants, 1.30 (1.10, 1.90) and 1.10 (0.88, 1.80) for infants at low altitude, 1.40 (1.00, 2.00) and 1.30 (0.99, 2.00) at mild altitudes, 1.90 (1.30, 2.50) and 1.80 (1.20, 2.70) at moderate altitudes, 1.80 (1.40, 3.50) and 2.20 (1.60, 4.30) for high altitudes, 3.20 (2.70, 3.70), and 3.10 (2.10, 3.30) for higher altitudes, respectively. Overall, both pre- and post-ductal PPI increased with altitude. The 50th percentile curves of pre- and post-ductal PPI values in well newborns at mild, low, moderate, and high altitudes were relatively similar, while the difference between the PPI curves of infants at higher altitudes and other altitudes was significantly different. Conclusions: With the increase of altitude, pre- and post-ductal PPI of newborns increases. Our study obtained the PPI reference values of asymptomatic well newborns at 6 to 72 h after birth at different altitudes from 4 to ≥ 4000 m. What is Known:• Monitoring hemodynamics is very important to neonates. As an accurate and reliable hemodynamic monitoring index, PPI can detect irreversible damage caused by insufficient tissue perfusion and oxygenation early, directly, noninvasively, and continuously. What is New:• Our study obtained the PPI reference values of asymptomatic well newborns at 6 to 72 h after birth at different altitudes from 4 to ≥ 4000 m. With the increase of altitude, pre- and post-ductal PPI of newborns increase with statistical significance. Therefore, the values and disease thresholds of PPI for asymptomatic neonates should be modified according to altitudes.
Newborn infants, especially those in the neonatal intensive care unit, tend to go through a transition period in early life including complex perfusion changes. Haemodynamic monitoring allows for early detection of diseases, thus improving outcomes and can be life-saving. A reliable modality of hemodynamic monitoring requires early, direct, non-invasive and continuous detection of irreversible damage caused by insufficient tissue perfusion and oxygenation. PPI has been embedded in the latest generation of pulse oximeters, which obtain data via a sensor attached to infants' palm or sole and emit 940 nm near-infrared light. Different tissues and blood vessels absorb different amounts of light, with the amount of light absorbed by pulsatile tissues-dynamic changes of arterial blood flow, and non-pulsatile tissues-venous blood, muscle and other tissues, being detected. The amount of light absorbed by non-pulsatile tissue is constant. PPI is the percentage of the former to the latter. 1 It reflects the real-time change of peripheral blood flow and is an evaluation of pulse intensity at specific monitoring sites. 2 In the newborn population, GA has a great impact on physiology. The early postnatal PPI values of newborns at different GAs may also be different. 1 Therefore, the range and thresholds of PPI values for detecting diseases in newborns should be modified according to different GA. 1 In addition, studies which investigated PPI were previously conducted at sea level but lacked data from other altitudes. 3
Background Intensive care is of great significance for very low birth weight infants (VLBWI). The Yangtze River Delta is the most ecomonically developed area in China. However, there are few data on the care practices and survival of VLBWI in this region. Objectives To investigate the prevalence, care practices and motality of VLBWI in Yangtze River Delta in China. Methods A multi-center retrospective investigation study was conducted at five tertiary hospitals within the Yangtze River Delta in China from January to December 2017. Clinical data included the general characteristics of the infants and the mothers, clinical prognosis, care practices in NICUs was collected by trained research members. Results During the study period, 1059 VLBWIs were included. Infants with birth weight < 750 g, 750-1000 g, 1000-1250 g and 1250-1500 g accounted for 2.3, 14.9, 34.8 and 47.8%, respectively. Premature rupture of membranes (17.8%) was the main cause of premature delivery. The catheterization rates of umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) were 25.0 and 64.4%, respectively. The duration of parenteral nutrition was 27.0 ± 19.5 d, the meantime of feeding tube indwelling was 36.2 ± 24.2 d. The corrected gestational age of the infants who reached full oral feeding was 35.8 ± 2.7 weeks. The breast feeding rate in the investigated infants was 61.9%. The mortality rate of preterm infants was 3.4%. The incidence of main complications BPD, PDA, ROP, NEC and sepsis were 24.9, 29.9, 21.7, 9.4 and 13.3% respectively. Conclusions Maternal and infant care practices need to be improved in the very preterm births. This study provides a baseline for the improvement in the further study.
Background Intensive care is of great significance for very and extremely low birth weight infants. Objectives To investigate the prevalence, care practices and motality of very and extremely low birth weight infants (VELBWI) in Yangtze River Delta in China. Methods A multi-center retrospective investigation study was conducted at five tertiary hospitals within the Yangtze River Delta in China from January to December 2017. Clinical data included the general characteristics of the infants and the mothers, clinical prognosis, care practices in NICUs was collected by trained research members. Results During the study period, 1059 VELBWIs were included. Infants with birth weight < 750g, 750-1000g, 1000-1250g and 1250-1500g accounted for 2.3%, 14.9%, 34.8% and 47.8%, respectively. Premature rupture of membranes (17.85%) was the main cause of premature delivery. The catheterization rates of umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) were 25.02% and 64.4%, respectively. The duration of parenteral nutrition was 27.0 ± 19.5 d, the meantime of feeding tube indwelling was 36.2 ± 24.2 d. The corrected gestational age of the infants who reached full oral feeding was 35.8 ± 2.7 weeks. The breast feeding rate in the investigated infants was 61.9%. The mortality rate of preterm infants was 3.4%. The incidence of main complications BPD, PDA, ROP, NEC and sepsis were 24.9%, 29.9%, 21.72%, 9.4% and 13.3% respectively. Conclusions Maternal and infant care practices need to be improved in the very preterm births. This study provides a baseline for the improvement in the further study.
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