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

ABSTRACT

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.