Peripheral Perfusion Index as a Marker of Sepsis in Preterm Neonates

Area of Science:

• Neonatalogy
• Critical Care Medicine
• Biomedical Engineering

Background:

• Neonatal sepsis is a leading cause of mortality in India, with current diagnostic methods like blood cultures being time-consuming (48-72 hours).
• Serological markers for sepsis often exhibit suboptimal diagnostic accuracy.
• Perfusion index (PI) offers a real-time, non-invasive method to detect microcirculatory changes indicative of sepsis before overt clinical signs emerge.

Purpose of the Study:

• To evaluate the diagnostic accuracy of Perfusion Index (PI) in identifying hospital-acquired sepsis in neonates.
• To determine if PI can serve as an early warning sign for sepsis before clinical manifestations become apparent.

Main Methods:

• A prospective observational study was conducted in a Neonatal Intensive Care Unit (NICU).
• Perfusion index (PI) was continuously monitored in preterm neonates.
• Clinical sepsis was diagnosed using the Neonatal Krankenhaus-Infektions-Surveillance-System (NeoKISS), and the time difference between PI fall and clinical sepsis diagnosis was calculated.

Main Results:

• The study included 65 preterm neonates, identifying 86 suspected sepsis events, with 69 sepsis screen positive and 15 culture-positive sepsis cases.
• Perfusion index (PI) demonstrated a sensitivity of 89.47% and a specificity of 56% in detecting hospital-acquired sepsis.
• The positive predictive value was 82.26%, and the negative predictive value was 70% for PI in this cohort.

Conclusions:

• Perfusion index (PI) shows potential as an early, non-invasive biomarker for hospital-acquired sepsis in preterm neonates.
• The findings suggest PI can aid in the timely detection of sepsis, potentially improving outcomes.