Decreased Variability and Low Values of Perfusion Index on Day One Are Associated with Adverse Outcome in Extremely Preterm Infants

• Published in: The Journal of pediatrics Vol. 178; pp. 119 - 124.e1
• Main Authors: Van Laere, David, MD, O'Toole, John M., PhD, Voeten, Michiel, MD, McKiernan, Joanne, PhD, Boylan, Geraldine B., PhD, Dempsey, Eugene, MD, FRCPI
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: circulation; Cohort Studies; Female; Gestational Age; Humans; Infant; Infant Mortality; Infant, Extremely Premature; Infant, Newborn; Infant, premature; Infant, Premature, Diseases - epidemiology; Male; Oximetry; Pediatrics; plethysmography; Plethysmography - methods; ELGAN; Infant, premature; Periventricular leukomalacia; circulation; PVL; GA; IVH; Intraventricular hemorrhage; plethysmography; Gestational age; Extremely low gestational age newborn
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.08.008

Objective To develop new quantitative features for the Perfusion Index signal recorded continuously over the first 24 hours of life in a cohort of extremely low gestational age newborns and to assess the association of these features with normal and adverse short-term outcome. Study design A cohort study of extremely low gestational age newborns. Adverse outcome was defined as early mortality before 72 hours of life, acquired severe periventricular-intraventricular hemorrhage, or severe cystic leukomalacia. Perfusion Index values were obtained from the plethysmographic signal of a pulse oximeter. Perfusion Index signals were separated into low-frequency (trend) and high-frequency (detrend) components. Three features were extracted during four 6-hour epochs: mean of the trend component (mean-trend), SD of the trend component (SD-trend), and SD of the detrend component (SD-detrend). The SD features represent long-term variability (SD-trend) and short-term variability (SD-detrend) of the Perfusion Index. A mixed-effects model was fitted to each feature. Results Ninety-nine infants were included in the analysis. Quadratic-time mixed-effects models provided the best fit for all 3 features. The mean-trend component was lower for the adverse outcome compared with the normal outcome group with a difference of 0.142 Perfusion Index ( P  = .001). SD-detrend component was also lower for the adverse compared with the normal outcome group, although this difference of 0.031 Perfusion Index/days2 was dependent on time ( P  < .001). Conclusion Low values and reduced short-term variability of Perfusion Index on day 1 are associated with adverse outcome