Relationship between perfusion index and patent ductus arteriosus in preterm infants

Gomez-Pomar, Enrique; Makhoul, Majd; Westgate, Philip M.; Ibonia, Katrina T; Patwardhan, Abhijit; Giannone, Peter J.; Bada, Henrietta S.; Jawdeh, Elie G. Abu

doi:10.1038/pr.2017.10

Cited by 26 publications

(17 citation statements)

References 35 publications

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“…The plethysmographic signal of pulse oximeter can be used to calculate ratio of the pulsatile and non-pulsatile components, described as Perfusion Index. This has been recently studied and is found to be reasonably predictive of low flow states, including patent ductus arteriosus ( 57 – 59 ). Reference values still need to be established in the preterm infant in whom PI is significantly affected by the transitional circulation, taking up to 72 h for the values to stabilize ( 59 ).…”

Section: Assessment Of Cardiac Output (Co) and Tissue Perfusionmentioning

confidence: 99%

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

2018

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Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pediatric population are often invasive and less feasible. We aim to discuss the pathophysiology in shock in newborn infants, including the transitional changes at birth and unique features that contribute to the challenges in early identification. Special emphasis has been placed on bedside focused echocardiography/focused cardiac ultrasound, which can be used as an additional tool for early, neonatologist driven, ongoing evaluation and management. An approach to goal oriented management of shock has been described and how bed side functional echocardiography can help in making a logical choice of intervention (fluid therapy, inotropic therapy or vasopressor therapy) in infants with shock.

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Section: Assessment Of Cardiac Output (Co) and Tissue Perfusionmentioning

confidence: 99%

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

2018

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“…However, some infants with PDA present for evaluation of an asymptomatic heart murmur with no overt clinical manifestations. 22,24,25 Endocan, a chondroitin sulfate/dermatan sulfate proteogly-can, is a novel human endothelial cell-specific molecule and can be measured in serum. The expression and distribution of endocan in normal human tissues such as skin, lungs, gastrointestinal tract, cardiovascular system, normal brain, liver, kidneys, and other organs have been shown.…”

Section: Discussionmentioning

confidence: 99%

Serum Endocan Level as a Predictive Marker for Hemodynamically Significant Patent Ductus Arteriosus in Very Low Birth Weight İnfants

et al. 2017

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Background Diagnosis and treatment of patent ductus arteriosus (PDA) in premature infants is still an important problem for clinicians. Echocardiography is the gold standard for determination of PDA based on clinical and hemodynamic significance. Clinical decision making may be aided by measuring circulating biomarkers such as natriuretic and endothelial propeptides. We aimed to investigate the significance of serum endocan and B-type natriuretic peptide (BNP) in the diagnosis and follow-up of hemodynamically significant PDA (hsPDA) in very low birth weight infants. Materials and Methods In this study, 84 premature infants with gestation age less than 32 weeks were included. Forty-two premature infants with hsPDA were determined as the study group and 42 premature infants without PDA were assigned as the control group. Blood samples were collected and analyzed for serum endocan and pro-BNP levels. Results Serum levels of pro-BNP and endocan in the study group at the time of diagnosis of PDA were found to be significantly higher than the control group, and the levels decreased significantly after medication. Multivariate regression analysis showed that birth weight and the presence of PDA were significantly correlated with serum endocan levels. The cutoff values of pro-BNP and endocan for PDA prediction were 290 pg/mL and 506 ng/mL, respectively. Conclusion Endocan and pro-BNP assays have clinical importance in the diagnosis, initiation therapy, and follow response to therapy in very low birth weight infants with hsPDA.

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“…Pulse oximeters were equipped with serial data recorders (Acumen Instruments Corp.) for continuous data collection. Novel programs were utilized to filter and analyze data (Matlab, Natick, MA, USA) ( 1 , 33 ). Data with artifacts were excluded.…”

Section: Methodsmentioning

confidence: 99%

Prenatal Opioid Exposure and Intermittent Hypoxemia in Preterm Infants: A Retrospective Assessment

et al. 2017

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IntroductionIntermittent hypoxemia (IH) is defined as episodic drops in oxygen saturation (SpO2). Preterm infants are at increased risk for IH due to their immature respiratory control/apnea of prematurity. The clinical relevance of IH is a relatively new observation with rising evidence linking IH to neonatal morbidities and long-term impairment. Hence, assessing factors that influence IH in preterm infants is imperative. Given the epidemic of opioid misuse in the USA, there is an urgent need to understand the impact of prenatal opioid exposure on neonatal outcomes. Hence, we wanted to assess the relationship between isolated prenatal opioid exposure and IH in preterm infants.MethodsIn order to accurately calculate IH, SpO2 data were prospectively collected using high-resolution pulse oximeters during the first 8 weeks of life in preterm infants less than 30 weeks gestational age. Data related to prenatal opioid misuse were retrospectively collected from medical charts. Infants with tobacco or poly-drug exposure were excluded. The primary outcome measure is percent time spent with SpO2 below 80% (%time-SpO2 < 80). The secondary outcome measure is the number of severe IH events/week with SpO2 less than 80% (IH-SpO2 < 80).ResultsA total of 82 infants with isolated opioid exposure (n = 14) or who were unexposed (n = 68) were included. There were no significant differences in baseline characteristics between opioid exposed and unexposed groups. There was a statistically significant increase of 0.23 (95% CI: 0.03, 0.43, p = 0.03) in mean of the square root of %time-SpO2 < 80. The number of IH-SpO2 < 80 events was higher in the opioid exposed group (mean difference = 2.95, 95% CI: −0.35, 6.25, p-value = 0.08), although statistical significance was not quite attained.ConclusionThis study shows that preterm infants prenatally exposed to opioids have increased IH measures compared to unexposed infants. Interestingly, the increased IH in the opioid exposed group persists beyond the immediate postnatal period.

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Relationship between perfusion index and patent ductus arteriosus in preterm infants

Abstract: Mean ΔPI, ΔPI variability, and mean pre-PI measured 4 h prior to echocardiography detect PDA in preterm infants. PI is dynamic and should be assessed continuously. Perfusion index is a promising bedside measurement to identify PDA in preterm infants.

Cited by 26 publications

References 35 publications

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

Serum Endocan Level as a Predictive Marker for Hemodynamically Significant Patent Ductus Arteriosus in Very Low Birth Weight İnfants

Prenatal Opioid Exposure and Intermittent Hypoxemia in Preterm Infants: A Retrospective Assessment

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