Does Perfusion Index in Term Neonate with Late-Onset Pneumonia Predict Disease Severity and Prognosis?

Objective: Pneumonia is an important disease that causes sepsis in newborns and constitutes the majority of deaths due to infections, especially in developing countries. Pulse oximeters that are widely used in clinics, can determine heart rate, arterial oxygen saturation, additionally perfusion index (PI). In this study, the role of PI in determining the severity and prognosis of the disease in newborns with late-onset pneumonia (LOP);the relationship between PI and respiratory support need and Silverman Anderson Retraction Score (SAS) were aimed to determine. Material(s) and Method(s): In this prospective study, 30 term newborns diagnosed with late-onset pneumonia (LOP) were at the time of hospitalization,at the 24th hours of their treatment, and discharge;in the control group, PI measurements were made from the right upper extremity every 10 seconds for 3 minutes at the discharge of 30 term healthy newborns between December 2017 and June 2018. By comparing the data, it was aimed to determine the relationship of PI with the severity of the disease, prognosis, need for respiratory support and Silverman Anderson Retraction Score (SAS). Result(s): Their mean birth weights was 2000 - 4600 g the mean was 3570 g in the study, 2800 - 4100 g the mean was 3610 g in the control group and there was no significant difference (p>0.05);Gestational ages were 365/7 - 413/7, mean 392/7 in the study group, 373/7 - 405/7 in the control group, mean 396/7 weeks, and the statistical difference between the groups was not significant (p>0.05). The ratio of female/male was similar in the groups. Their median age was 9.5 days (3-27) in the control, 21 days (5-28) in the study group, and higher in the study group (p<0.05). The median capillary refill time was 1.7 seconds in the control, 1.6 seconds in the study group, and similar between the groups. The mean PI was 2.3+/-0.9 in the control group. In the study group, it was 3.6+/-1.2 on hospitalization, 3.2+/-1.2 on the first day, 3.4+/-0.7 at discharge. In the study group, PI values on hospitalization and first day were higher (p<0.05). There were reticular infiltration 50% bilateral, 30% right paracardiac, 10% left paracardiac, 3.3% right lower lobe. Alpha hemolytic streptococci in 1 (3.3%), Acinetobacter iwoffii in 1 (3.3%), Respiratory syncytial virus 6 (20%), Coronavirus 4 (13.3%), Rhinovirus 2 (6.7%) and Influenza A 1 (3.3%) patient were determined. We applied free flow oxygen 17 (56.7%), oxygen by hood 5 (16.7%), heated humidified high-flow nasal cannula 1 (3.3%), nasal continuous airway pressure 4 (13.3%), nasal intermittent positive pressure ventilation 4 (13.3%) cases. PI was higher in the patients needing positive pressure on admission (p<0.05). A positive correlation was found between SAS and PI on admission in the study group (p=0.008). The number of patients whose PI decreased during hospitalization increased over time. Conclusion(s): In the neonates with LOP, the severity of the disease, the need for respiratory support and prognosis cannot be predicted by PI. There was no relation between SAS and PI. It was concluded that more accurate results can be achieved by measuring PI using more patients, more sensitive probes and technically more advanced monitors. New studies should be conducted to determine the role of PI in demonstrating well-being and early detection of life-threatening conditions in the healthy newborns. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Serum ionized calcium levels may be more closely related to the admission qtc interval than total calcium levels in patients hospitalized with covid-19

Hypocalcemia prolongs the QTc interval. Total calcium (TCa) measurement can be misleading in cases where the concentration of albumin is abnormal. We aimed to investigate which calcium level —ionized calcium (iCa) or TCa—may be more closely related to the QTc interval in COVID-19 patients in whom hypocalcemia and hypoalbuminemia are observed frequently. Adult patients hospitalized for COVID-19 were included in this study. ICa levels were obtained from the venous blood gas sample examined during the emergency department admission, and the TCa levels were obtained from the biochemistry results on admission. The pH-adjusted iCa (Corrected-iCa) and albumin-adjusted TCa (corrected-TCa) were calculated. The QT interval was measured from the admission ECG and corrected for heart rate using the Bazett formula. Hundred and thirty-two patients were included in the study. The mean age was 50±19 years, and 62 (47%) patients were female. Median iCa level was 1,13 mmol/L (1,08-1,18 interquartile range (IQR)), median TCa level was 2.13 mmol/L (2.02-2.22 IQR). 76 patients (57%) had hypocalcemia (iCa<1,16 mmol/L). The median QTc interva l was 431 ms (414-450 IQR). In the multivariable linear regression analysis, a significant relationship was observed between the QTc interval and iCa and corrected-iCa levels (β=-2.22, standard error (SE) =27.839, p=0.028, β=-2.16, SE=29.407, p=0.033), but no significant relationship was observed between TCa and corrected-TCa levels (β=-1.02, SE=3.959, p=0.312, β=-0.44, SE=4.635, p=0,650). A significant relationship was observed between iCa levels and the QTc interval, which was longer in patients with hypocalcemia, but there was no significant relationship observed with TCa levels.