Perfusion Index Trajectory Analysis: Predictive Ability for Short-Term Complications in Preterm Newb

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Baquero-Latorre H, et al., J Neonatol Clin Pediatr 2021, 8: 067 DOI: 10.24966/NCP-878X/100067

HSOA Journal of Neonatology and Clinical Pediatrics Research Article

Perfusion Index Trajectory Analysis: Predictive Ability for Short-Term Complications in Preterm Newborns Hernando Baquero-Latorre1, Julián Alfredo Fernández-Niño2*, Laura Juliana Bonilla-Tinoco3, Iván De la Peña4 and Augusto Sola5 Departamento de Medicina, Universidad del Norte, Barranquilla, Atlántico, Colombia and Member of Honor, Ibero-American Society of Neonatology (SIBEN), Fort Lauderdale, Florida, USA

1

Departamento de Salud Pública, Universidad del Norte, Barranquilla, Atlántico, Colombia

2

Departamento de Salud Pública, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia

3

Departamento de Medicina, Universidad del Norte, Barranquilla, Atlántico, Colombia

4

Medical Director,Ibero-American Society of Neonatology (SIBEN), Fort Lauderdale, Florida, USA and VP, Medical Affairs Neonatology, Masimo, Irvine, CA

5

Abstract The aim of this study was to determine the predictability of clinical complications by analyzing the perfusion index historical behavior patterns with polynomial group-based trajectory model. A longitudinal analysis was performed in 80 preterm newborns (gestational age 24 to 36 weeks) in a neonatal intensive care unit. The perfusion index was measured continuously at the pre-ductal level in the upper right limb, using the Masimo Radical-7 pulse oximeter during the first 72 hours of life. Measurements were made every two seconds, but for analysis purposes, these data were smoothed using the perfusion index mean per minute and the monitoring time was divided into 6-hour periods. Logistic regression models were used to assess the perfusion index ability to predict a complication in each of the 6-hour periods. Additionally, polynomial group-based trajectory model was conducted to determine behavior patterns and to explore their *Corresponding author: Julián Alfredo Fernández-Niño, Departamento de Salud Pública, Universidad del Norte, Barranquilla, Atlántico, Colombia, Tel: +57 3222710145; E-mail: aninoj@uninorte.edu.co Citation: Baquero-Latorre H, Fernández-Niño JA, Bonilla-Tinoco LJ, la Peña ID, Sola A (2021) Perfusion Index Trajectory Analysis: Predictive Ability for ShortTerm Complications in Preterm Newborns. J Neonatol Clin Pediatr 8: 067. Received: February 24, 2021; Accepted: February 26, 2021; Published: March 05, 2021 Copyright: © 2021 Baquero-Latorre H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

association with each clinical complication that occurred during the first seven days of life. We found the perfusion index significantly reduced the likelihood of necrotizing enterocolitis at the 42-48 (OR = 0.16; CI95% 0.04-0.68) and 48-54 (OR = 0.17; CI95% 0.04-0.72) hours periods after birth. The trajectory analysis identified two trajectory profiles, so that membership to the trajectory 1profile was significantly associated with the presence of a clinical complication (OR = 8.85; IC95% 1.03-76.51). The use of a trajectory analysis with standardized individual trends of the perfusion index historical behavior allowed the identification of patterns that predict clinical complications in preterm infants. Keywords: Arterial Inflow; Interquartile range; Neonatal intensive care unit; Photoplethysmogram

Introduction Newborns, particularly preterm infants, have a number of characteristics that make them more vulnerable to certain situations of clinical instability. One of them, and perhaps the most critical, is circulatory deterioration. The physiological responses to such events differ from those of other population groups, making them more vulnerable to tissue hypoxia and organ failure. This makes it imperative for early recognition and therapeutic intervention in situations that compromise cardiovascular function. One of the measures that can be used to evaluate and monitor the hemodynamic status of a newborn is the perfusion Index (PI), which is a relative, indirect and non-invasive measure of the strength of the peripheral perfusion. The PI is the ratio between the pulsatile component during Arterial Inflow (AC) and the non-Pulsatile Component (DC) of the Photoplethysmogram (PPG) signal, which are both derived from the amount of absorbed infrared light (940-nm)emitted by a pulse oximeter [1,2]. Additionally, the PPG waveform can also be used to assess the microcirculation of neonates. The technological progress of pulse oximeters has enabled a reliable and safe monitoring of the PI for clinical analysis of blood flow. Furthermore, the literature has recently been focused on understanding the relationship between this new clinical monitoring tool and the complex neonatal cardiovascular physiology, as described in a 2014 review [1]. Thus, PI shows the relationship between heart function and peripheral vascular resistance, thereby assessing the pulsating force at a specific monitoring site (e.g. hand, finger or toe). PI depends mainly on the amount of blood at the site where it is measured, so it becomes an indirect, non-invasive measurement of the peripheral perfusion. In summary, it is a relative assessment of the strength of the arterial pulse at the monitoring site, which quantifies its amplitude and yields clinically useful information about the peripheral perfusion status. A low PI represents less flow at the sensor site, which may be attributed to local compression, peripheral vasoconstriction, hypovolemia, or reduced cardiac function; where as a high PI suggests vasodilation. The PI varies according to the


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