Early human development · 2026
Association of cardiac perfusion index with cerebral regional oxygen saturation and fractional tissue oxygen extraction in preterm infants.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Li Junran, Shen Cuncun, Liu Sudan, Zhang Ming, Ma Jing, Fan Tao, He Lanlan, Qiao Yanxia, Qiu Jingjing
Аннотация
OBJECTIVE: Preterm infants face elevated risk of cerebral oxygen dysregulation due to immature cerebrovascular autoregulation and systemic hemodynamic instability. Near-infrared spectroscopy (NIRS)-derived cerebral regional oxygen saturation (rSO₂) and fractional tissue oxygen extraction (FTOE) provide continuous, noninvasive surrogates of cerebral oxygen delivery and utilization balance. The cardiac perfusion index (PI), obtained simultaneously via pulse oximetry, reflects peripheral microvascular perfusion and may correlate with central hemodynamic status. This study aimed to characterize the longitudinal association between PI and cerebral rSO₂ and FTOE in preterm infants stratified by oxygenation status.
STUDY DESIGN: This retrospective observational study enrolled 200 preterm infants (gestational age < 37 weeks; birth weight < 2500 g) admitted to the Neonatal Intensive Care Unit (NICU) of XXX Hospital between March 2021 and March 2022. Infants were stratified into a healthy group (n = 100; no clinical or biochemical evidence of hypoxia) and a disease group (n = 100; conditions impairing regional cerebral oxygenation: respiratory disease, circulatory disease, or brain injury). PI was recorded continuously by pulse oximetry on the right upper limb palm (10 measurements at 6-s intervals, mean value retained). Cerebral rSO₂ was measured using NIRS (EGOS-600 A) with probe at the frontal midline, values recorded after 2 min of signal stabilization. FTOE was calculated as (SpO₂ - rSO₂) / SpO₂. Measurements were performed on postnatal Days 1, 2, and 3.
RESULTS: The disease group demonstrated significantly lower PI across all postnatal days (Day 1: 0.68 ± 0.28 vs. 0.96 ± 0.36, mean difference 0.29, 95% CI: 0.20-0.37; Day 3: 0.93 ± 0.38 vs. 1.21 ± 0.43; p < 0.001 for all). Cerebral rSO₂ was consistently lower (Day 1: 68.54 ± 7.27% vs. 75.78 ± 5.88%; p < 0.001) and FTOE was higher (Day 1: 0.24 ± 0.07 vs. 0.20 ± 0.06; p < 0.001) in the disease group. PI was positively correlated with rSO₂ (Day 1: r = 0.425; Day 3: r = 0.560; all p < 0.001) and inversely correlated with FTOE (Day 1: r = -0.301; Day 3: r = -0.493; all p < 0.001). ROC analysis identified an optimal PI cutoff of 0.81 for detecting cerebral hypoxia (rSO₂ < 70%), with AUC 0.743 (95% CI: 0.673-0.809), sensitivity 0.782, and specificity 0.607.
CONCLUSION: Cardiac PI is significantly associated with cerebral rSO₂ and FTOE in preterm infants during the first three postnatal days, with associations strengthening over time. A PI ≤0.81 may be considered as a screening threshold to identify infants for more definitive cerebral oxygenation assessment, supported by its high negative predictive value. Integrating PI monitoring with NIRS-based cerebral surveillance may enhance early identification of infants with possible cerebral hypoxia.
STUDY DESIGN: This retrospective observational study enrolled 200 preterm infants (gestational age < 37 weeks; birth weight < 2500 g) admitted to the Neonatal Intensive Care Unit (NICU) of XXX Hospital between March 2021 and March 2022. Infants were stratified into a healthy group (n = 100; no clinical or biochemical evidence of hypoxia) and a disease group (n = 100; conditions impairing regional cerebral oxygenation: respiratory disease, circulatory disease, or brain injury). PI was recorded continuously by pulse oximetry on the right upper limb palm (10 measurements at 6-s intervals, mean value retained). Cerebral rSO₂ was measured using NIRS (EGOS-600 A) with probe at the frontal midline, values recorded after 2 min of signal stabilization. FTOE was calculated as (SpO₂ - rSO₂) / SpO₂. Measurements were performed on postnatal Days 1, 2, and 3.
RESULTS: The disease group demonstrated significantly lower PI across all postnatal days (Day 1: 0.68 ± 0.28 vs. 0.96 ± 0.36, mean difference 0.29, 95% CI: 0.20-0.37; Day 3: 0.93 ± 0.38 vs. 1.21 ± 0.43; p < 0.001 for all). Cerebral rSO₂ was consistently lower (Day 1: 68.54 ± 7.27% vs. 75.78 ± 5.88%; p < 0.001) and FTOE was higher (Day 1: 0.24 ± 0.07 vs. 0.20 ± 0.06; p < 0.001) in the disease group. PI was positively correlated with rSO₂ (Day 1: r = 0.425; Day 3: r = 0.560; all p < 0.001) and inversely correlated with FTOE (Day 1: r = -0.301; Day 3: r = -0.493; all p < 0.001). ROC analysis identified an optimal PI cutoff of 0.81 for detecting cerebral hypoxia (rSO₂ < 70%), with AUC 0.743 (95% CI: 0.673-0.809), sensitivity 0.782, and specificity 0.607.
CONCLUSION: Cardiac PI is significantly associated with cerebral rSO₂ and FTOE in preterm infants during the first three postnatal days, with associations strengthening over time. A PI ≤0.81 may be considered as a screening threshold to identify infants for more definitive cerebral oxygenation assessment, supported by its high negative predictive value. Integrating PI monitoring with NIRS-based cerebral surveillance may enhance early identification of infants with possible cerebral hypoxia.