Divison of Neonatology, Department of Pediatrics, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
Department of Pediatric Cardiology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
Eur J Pediatr. 2021 Jun;180(6):1747-1754. doi: 10.1007/s00431-021-03937-z. Epub 2021 Jan 24.
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 (SpO) < 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.
动脉导管未闭（PDA）对生命体征趋势的影响表现为直方图，特别是灌注指数，目前尚不清楚。本研究旨在将连续获得的 PI 和其他生命体征在 PDA 治疗前后分为直方图箱，并确定 PI 和其他生命体征直方图在早期预测具有血流动力学意义的 PDA（hsPDA）中的效用。在 34 名平均胎龄为 26±2.1 周的婴儿中，我们前瞻性地在开始治疗 PDA 前、治疗期间和治疗结束后 24 小时收集了三个不同时期的生命体征，并通过回声确认 PDA 闭合。从不需要治疗 PDA 的早产儿中获得了具有三个可比时期的直方图，并进行了分析比较。确定了每个时间点每个直方图箱中花费的时间。与治疗期间和治疗后相比，治疗前患有 PDA 的婴儿中，PI <0.4 和 PI >2 的低 PI 持续时间明显更长。动脉血氧饱和度（SpO）<80%的持续时间也更长，治疗前患有 PDA 的婴儿与治疗期间和治疗后患有 PDA 的婴儿相比。低 PI <0.4 与 hsPDA 的大多数超声心动图指数相关。结论：我们的结论是，胎龄≤29 周的需要治疗的早产儿动脉导管未闭与低 PI <0.4 与高 PI >2 之间的显著波动相关，反映了 hsPDA 分流量的动态性质。PI 变异性可能是 hsPDA 的早期标志物。已知：• 灌注指数是脉搏血氧饱和度提供的一个未充分利用的连续参数，用于评估外周灌注。• 灌注指数有助于预测具有血流动力学不稳定的情况。新内容：• 作为日常直方图趋势评估的灌注指数可以预测需要治疗的动脉导管未闭。
