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Updated: Nov 20, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
The perfusion index histograms predict patent ductus arteriosus requiring treatment in preterm infants
Asmaa A Osman1, Muflih Albalawi2, Shyamala Dakshinamurti3,4
1Divison of Neonatology, Department of Pediatrics, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
Insights
Patent ductus arteriosus (PDA) in preterm infants is linked to significant perfusion index (PI) fluctuations. PI variability, assessed via histograms, may serve as an early predictor for hemodynamically significant PDA requiring treatment.
Area of Science:
- Neonatal physiology
- Cardiovascular research
- Medical device technology
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants, potentially causing hemodynamic instability.
- Perfusion index (PI) from pulse oximetry is an underutilized parameter for assessing peripheral perfusion and hemodynamic status.
Purpose of the Study:
- To investigate the impact of PDA on vital sign trends, specifically perfusion index (PI) histograms.
- To determine if PI histograms can predict hemodynamically significant PDA (hsPDA) in preterm infants.
Main Methods:
- Prospective collection of vital signs, including PI, in 34 preterm infants (mean GA 26 weeks) during three periods: before, during, and after PDA treatment.
- Analysis of PI and SpO2 histogram bin durations, compared between infants with and without PDA requiring treatment.
- Correlation of PI values with echocardiography indices of hsPDA.
Main Results:
- Infants with PDA requiring treatment showed significantly longer durations of low PI (<0.4) and high PI (>2) before treatment compared to during and after.
- Prolonged durations of low SpO2 (<80%) were also observed before PDA treatment.
- Low PI (<0.4) correlated with echocardiographic indicators of hsPDA.
Conclusions:
- PDA requiring treatment in preterm infants (≤29 weeks GA) is associated with significant PI variability (low alternating with high).
- PI histogram trends may serve as an early, non-invasive marker for identifying hsPDA.
- This approach offers potential for earlier detection and management of PDA-related hemodynamic issues.
Abstract:
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 (SpO2) < 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.
