Peripheral Perfusion Index as a Marker of Sepsis in Preterm Neonates

Singh, Jasmine; Jain, Suksham; Chawla, Deepak; Randev, Shivani; Khurana, Supreet

doi:10.1093/tropej/fmac014

Cited by 3 publications

(3 citation statements)

References 26 publications

(20 reference statements)

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“…However, PI did not show an independent association with in-hospital mortality on multivariable analysis. Although there are no conclusive studies in neonates, [12][13][14] some studies in older age groups have found PI to be an independent predictor of mortality in out-of-hospital cardiac arrest, 22 sepsis associated acute kidney injury. 23 Lack TA B L E 2 Perfusion index and plethysmography variability index values in neonates with proven/probable sepsis and no-sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis

et al. 2023

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Aim(i) To compare perfusion index (PI) and plethysmography variability index (PVI) between neonates with proven or probable sepsis versus no‐sepsis, (ii) to examine an association of PI and PVI with in‐hospital mortality.MethodsWe enrolled neonates with clinically presumed sepsis. Culture‐proven or probable sepsis were categorised as ‘cases’ and no‐sepsis as ‘controls’. PI and PVI were recorded hourly for 120 h and averaged in 20‐time epochs (0–6 h to 115–120 h).ResultsWe analysed 148 neonates with sepsis (proven sepsis = 77, probable sepsis = 71) and 126 with no‐sepsis. Neonates with proven/probable sepsis and no‐sepsis had comparable PI and PVI values. Among 148 neonates with sepsis, 43 (29%) died. Non‐survivors had significantly lower PI values than survivors (mean difference 0.21 [95% CI 0.14–0.29], p‐value <0.001). PI had a significant but modest discriminative ability to identify non‐survivors. However, PI did not independently predict mortality.ConclusionNeonates with proven/probable sepsis and no‐sepsis had comparable PI and PVI values in the first 120 h of sepsis. PI but not PVI values were significantly lower in non‐survivors than survivors. PI did not independently predict in‐hospital mortality. Due to modest discriminative ability, PI should be interpreted along with other vital signs to take clinical decisions.

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Section: Discussionmentioning

confidence: 99%

“…These parameters may have the potential to inform mortality in sick patients 10 . PI has shown to be decreased in neonates born to mothers with chorioamnionitis, 11,12 neonates with sepsis 13,14 and shock 15 . PVI has been used to identify volume responsiveness in neonates and infants 16,17 .…”

Section: Introductionmentioning

confidence: 99%

Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis

et al. 2023

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“…It has also been reported that it reflects real-time changes in peripheral blood flow and determines inadequate peripheral perfusion in newborns suffering critical disease. 7,8 Therefore, when there is a decrease in arterial circulation due to reduced stroke volume, decreased perfusion index is expected. Monitoring the perfusion of less vital organs such as skin, subcutaneous tissue, and muscle will give an idea about how more vital tissues are perfused.…”

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Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns

et al. 2023

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Introduction: Peripheral perfusion index has been proposed as a possible method for detecting circulatory impairment. We aimed to determine the normal range of peripheral perfusion index in healthy newborns and compare it with that of newborns with CHD. Methods: Right-hand saturation and right-hand peripheral perfusion index levels were recorded, and physical examination and echocardiography were performed in newborns who were 0–28 days old and whom were evaluated in our paediatric cardiology outpatient clinic. The saturation and peripheral perfusion index levels of newborns with normal heart anatomy and function were compared with those of newborns with CHD. Results: Out of 358 newborns (238 mature and 75 premature) enrolled in the study, 39 had CHD (20 mild CHD, 13 moderate CHD, and 6 severe CHD), of which 29 had CHD with left-to-right shunting, 5 had obstructive CHD, and 5 had cyanotic CHD. No newborn had clinical signs of hypoperfusion or heart failure, such as prolonged capillary refill, weakened pulses, or coldness of extremities. Peripheral perfusion index level was median (interquartile range) 1.7 (0.6) in healthy newborns, 1.8 (0.7) in newborns with mild CHD, and 1.8 (0.4) in newborns with moderate and severe CHD, and there was no significant difference between the groups regarding peripheral perfusion index level. Conclusion: Peripheral perfusion index remains unchanged in newborns with CHD without the clinical signs of hypoperfusion or heart failure. Larger studies with repeated peripheral perfusion index measurements can determine how valuable this method will be in the follow-up of newborns with CHD.

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Vasoactive inotropic score as a predictor of mortality in neonatal septic shock

Demirhan

Topçuoğlu

Karadağ

et al. 2022

Journal of Tropical Pediatrics

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Background Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock. Methods Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VIS values were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents. Results The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p < 0.001), followed by the VIS48 (0.802, p < 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p < 0.001, β = 14.7, 95% confidence interval [4.7–45.9]). Conclusion We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.

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Peripheral Perfusion Index as a Marker of Sepsis in Preterm Neonates

Cited by 3 publications

References 26 publications

Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis

Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis

Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns

Vasoactive inotropic score as a predictor of mortality in neonatal septic shock

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