First Day of Life Reference Values for Pleth Variability Index in Spontaneously Breathing Term Newborns

Abstract

Background: The perfusion index (PI), derived from the pulse oximetry signal, has been shown to be an accurate predictor for identifying high illness severity in neonates. The plethysmographic variability index (PVI) is a measure of the dynamic change in PI occurring during a complete respiratory cycle. Objectives: The aim of this study was to establish the reference range of PVI in spontaneously breathing term newborns. Methods: PI and PVI values were assessed in 242 term newborns during the first day of life. Results: The median PVI value on the first day of life was 20% [95% confidence interval (CI) for the mean 19–20%; inter-quartile range 15 (95% CI 15–16) – 24 (95% CI 23–24)]. The 10th and 90th percentile cutoff values were 12% (95% CI 11–12) and 28% (95% CI 27–29), respectively, with the 97.5th percentile of 35% (95% CI 34–38). PVI was also significantly influenced by the behavioral status of the newborn, and was positively correlated with PI and pulse rate, while it was inversely correlated with oxygen saturation (p < 0.0001). Conclusions: Our findings suggest: (1) evaluation of PVI values is an easily applicable, noninvasive procedure for monitoring early postnatal respiratory changes in newborns, and (2) the feasibility of a noninvasive pulse-oximeter postnatal screening for early identification of adverse neonatal cardiorespiratory outcomes.

Perfusion index and its dynamic changes in preterm neonates with patent ductus arteriosus

“…PVI thus appeared inversely related to cardiac preload, as already demonstrated in spontaneously breathing healthy adults (26). In healthyterm neonates, an increase in PVI during crying and its positive correlation with heart rate also suggest that this parameter may be an indirect marker of cardiac preload (23).…”

“…In paediatrics, two recent studies reported controversial results about the accuracy of dynamic variables derived from the plethysmographic waveform to predict fluid responsiveness for mechanically ventilated patients under general anaesthesia (21,22). In neonatology, a median PVI value of 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)% was recently reported in spontaneously breathing-term neonates on the first day of life, mainly influenced by the behavioural status of the newborn (23). Our study is the first to record PVI values in premature neonates during IPPV, but these conditions did not result in major differences regarding the PVI data.…”

“…Our study is the first to record PVI values in premature neonates during IPPV, but these conditions did not result in major differences regarding the PVI data. Our median value of 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)% was slightly higher than the reference provided above, and it is unlikely that the difference was due to the discomfort of mechanical ventilation, as PVI usually reaches values greater than 35% in agitated neonates (23). Furthermore, we recently added a pain and discomfort module to the NICU's computerized physician order entry system, and thus far, it seems to be an effective means to improve systematic evaluation in premature newborns under invasive ventilation (24).…”

“…Plethysmographic variability index was 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27). None of the perinatal characteristics listed in Table 1, including postnatal age, had a significant influence on PVI.…”

Hemodynamic monitoring on the background of intensive therapy in newborns

“…Имеются также данные о том, что вариабельность амплитуды пульсовой волны отра-жает преднагрузку у пациентов на спонтанном ды-хании [13,22,36].…”