Perfusion Index as a Screening Tool for Patent Ductus Arteriosus

author.DisplayName 1 author.DisplayName 2 author.DisplayName 2 author.DisplayName 2 author.DisplayName 3 author.DisplayName 4
1Pediatrics, Cohen Children's Medical Center, USA
2Pediatrics/Cardiothoracic Surgery, Shaare Zedek Medical Center, Israel
3Applied Physics/Electro-Optics, Lev Academic Cener, Israel
4Pediatrics, Schneider Children's Medical Center of Israel, Israel

Background: Hemodynamically significant patent ductus arteriosus (hsPDA) is of clinical interest in preterm neonates. Perfusion Index (PI) is the percent change between systole and diastole in the amount of light that passes through tissue as measured by photoplethysmography. PI reflects peripheral perfusion and may have utility as a screening tool for hsPDA.

Methods: Pre- and post-ductal PI was measured in preterm neonates (24-34 weeks gestation) undergoing echocardiographic PDA evaluation. Ductal status was defined as hsPDA (including borderline hsPDA) or closed. Sensitivity and specificity were determined by ROC analysis.

Results: 19 neonates with hsPDA and 22 with closed ducti were assessed. Birthweight, gestation, and day of life (DOL) were similar between groups. PI was increased in neonates with hsPDA. When stratified by postnatal age, this difference is significant only after DOL 7.

Group

Pre-ductal PI

Post-ductal PI

Pre-ductal PI

Post-ductal PI

Pre-ductal PI

Post-ductal PI

(All) N=22,26

(<7 DOL) N=10,8

(>8 DOL) N=12,18

hsPDA

1.86 +0.68

1.75+0.86

1.73 +0.82

1.29 +0.52

1.98 +

0.53

2.14 +0.91

No PDA

1.43 +0.41

1.14+0.38

1.40 +0.26

1.14 +0.40

1.44 +0.47

1.14 +0.39

Significance

P=0.008

P=0.002

P=0.290

P=0.504

P=0.006

P<0.001

After DOL 7, a post-ductal PI cutpoint of 1.7 has 77% sensitivity and 95% specificity in predicting hsPDA and a cutpoint of 1.34 has 92% sensitivity and 68% specificity.

Discussion: PI is greater in neonates with hsPDA than in normal neonates and this difference is most significant after DOL 7 when pulmonary resistance decreases. Higher PI probably does not reflect better perfusion but rather, decreased diastolic blood volume due to retrograde diastolic flow that affects both pre-ductal and post-ductal arteries.

Conclusion: PI may serve as a screening tool for hsPDA after DOL 7.









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