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The perfusion index histograms predict patent ductus arteriosus requiring treatment in preterm infants

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Abstract

The impact of patent ductus arteriosus (PDA) on vital sign trends represented as histograms, and perfusion index in particular, is unknown. This study aimed to split continuously obtained PI and other vital signs before, during, and after medical treatment of PDA, into histogram bins, and determine the utility of PI and other vital sign histograms in the early prediction of hemodynamically significant PDA (hsPDA). In 34 infants at a mean gestational age of 26 ± 2.1 weeks, we prospectively collected vital signs for three different periods, 24 h before starting treatment of PDA, during PDA treatment, and 24 h after completion of the course of treatment, and confirmed PDA closure by echo. Histograms with three comparable periods were obtained from preterm infants who did not require treatment for PDA and analyzed for comparison. The duration of time spent in each histogram bin was determined for each time epoch. Episodes of low PI < 0.4 and high PI > 2 were significantly longer in duration in infants with PDA before treatment compared to those in infants with PDA during and after treatment. The arterial oxygen saturation (SpO2) < 80% was also longer in duration in infants with PDA before compared to that in infants with PDA during and after treatment. Low PI < 0.4 correlated with most echocardiography indices of hsPDA.

Conclusion: We conclude that a patent ductus arteriosus requiring treatment in preterm infants ≤ 29 weeks GA was associated with significant fluctuations between a low PI < 0.4 alternating with a high PI > 2, reflecting the dynamic nature of hsPDA shunt volume. PI variability may be an early marker of hsPDA.

What is Known:

• The perfusion index is a continuous underutilized parameter provided by pulse oximetry to assess the peripheral perfusion.

• The perfusion index helps predict conditions with hemodynamic instability.

What is New:

• The perfusion index assessed as daily histogram trends can predict patent ductus arteriosus requiring treatment.

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Data availability

All data and original material are available for transparency.

Abbreviations

ABP:

Arterial blood pressure

DBP:

Diastolic blood pressure

hsPDA:

Hemodynamically significant patent ductus arteriosus

HR:

Heart rate

MBP:

Mean blood pressure

PDA:

Patent ductus arteriosus

PI:

Perfusion index

SpO2 :

Oxygen saturation measured by pulse oximetry

SBP:

Systolic blood pressure

Echo:

Neonatal echocardiography performed by a pediatric cardiologist

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Author information

Authors and Affiliations

  1. Divison of Neonatology, Department of Pediatrics, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

    Asmaa A. Osman

  2. Department of Pediatric Cardiology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

    Muflih Albalawi

  3. Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Shyamala Dakshinamurti & Yasser Elsayed

  4. Biology of Breathing Theme, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

    Shyamala Dakshinamurti & Martha Hinton

  5. Faculty of Medicine, Misr University of Science and Technology, Cairo, Egypt

    Fatema Elhawary

  6. Department of Pediatrics and Neonatology, Tanta University Hospital, Tanta, Egypt

    Wegdan Mawlana

  7. Women’s Hospital, 820 Sherbrook Street, R2016, Winnipeg, Manitoba, R3A0L8, Canada

    Yasser Elsayed

Authors
  1. Asmaa A. Osman
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  3. Shyamala Dakshinamurti
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  4. Martha Hinton
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  5. Fatema Elhawary
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  6. Wegdan Mawlana
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  7. Yasser Elsayed
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Contributions

All authors made a substantial contribution to the manuscript and the design of the work: Asmaa Osman was the principal investigator and collected the data, Fatema Elhawary helped in data analysis, Muflih Albalawi performed the required echocardiography studies, and Shyamala Dakshinamurti and Martha Hinton performed the revised statistical analysis and the language. Yasser Elsayed was the principal supervisor, Asmaa Osman and Wegdan Mawlana helped in writing the manuscript, and Yasser Elsayed is the external expert in hemodynamics who designed the protocol included in the manuscript.

Corresponding author

Correspondence to Yasser Elsayed.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethical committee of King Salman Armed Forces Hospital for data collection and publication.

Statement of informed consent

The consent was obtained from parents of all recruited infants for data collection and publication.

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Communicated by Daniele De Luca

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Communicated by Daniele De Luca

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Osman, A.A., Albalawi, M., Dakshinamurti, S. et al. The perfusion index histograms predict patent ductus arteriosus requiring treatment in preterm infants. Eur J Pediatr 180, 1747–1754 (2021). https://doi.org/10.1007/s00431-021-03937-z

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  • DOI: https://doi.org/10.1007/s00431-021-03937-z

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