Perfusion index assessment during transition period of newborns: an observational study.

Sezin Unal,Nilgun Altuntas,Esin Koc,Ebru Kazanci,Serdar Beken,Ebru Ergenekon,Esra Onal,Selma Aktas,Yildiz Atalay,Ibrahim M Hirfanoglu,Canan Turkyilmaz,Ferit Kulali

doi:10.1186/s12887-016-0701-z

Abstract

BackgroundPerfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as “delayed transition”, others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them. We aimed to compare PI of neonates with TTN and delayed transition with controls, and assess its value on discrimination of delayed transition and TTN.MethodsNeonates with gestational age between 37 and 40 weeks who were born with elective caesarian section were included. Eligible neonates were monitored with Masimo Set Radical7 pulse-oximeter (Masimo Corp., Irvine, CA, USA). Postductal PI, oxygen saturation and heart rate were manually recorded every 10 s for 3 min for two defined time periods as 10th minute and 1st hour. Axillary temperature were also recorded. Newborn infants were grouped as control, delayed transition, and TTN.ResultsForty-nine tachypneic (TTN; 21, delayed transition; 28) and 30 healthy neonates completed the study. PI values were similar between three groups at both periods. There were no correlation between PI and respiratory rate, heart rate, and temperature.ConclusionPI assessment in maternity unit does not discriminate TTN from delayed transitional period in newborns which may indicate that peripheral perfusion is not severely affected in either condition.

Highlights

Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively
The study included 21 neonates with transient tachypnea of newborn (TTN), 28 neonates with delayed transition, and 30 neonates with normal respiratory rates, all born after elective caesarian section (C/S)
Ratio of early-term neonates were comparable in three groups, gestational age was found to be higher in neonates with delayed transition when compared to TTN (Table 1)

Summary

Introduction

Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. The TTN which is seen in 5.7– 9.7 % of term newborns during the transitional period [7, 8], accounts for the majority of respiratory morbidities requiring neonatal intensive care unit (NICU) admission in term infants, and is a diagnosis of exclusion [9]. It is characterized by pulmonary edema resulting from delayed resorption and clearance of fetal alveolar fluid [10]. If respiratory distress in these neonates resolves within 6 h of birth, it is called “delayed transition” [11]

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