Utilizing perfusion index for early identification of circulatory shock in neonates

Neonatal circulatory shock poses a significant challenge in intensive care settings and necessitates early recognition and intervention to prevent adverse outcomes. The perfusion index (PI), derived from pulse oximetry signals, is a potential adjunct tool for assessing peripheral perfusion and predicting shock in neonates. This prospective observational study aimed to evaluate the correlation between PI and circulatory shock in neonates with the goal of establishing PI as an objective parameter for early shock identification.

Study was conducted in the neonatal intensive care unit (NICU) of Saveetha Medical College Hospital, India, in 2023, between January and June. This study enrolled 100 neonates who underwent hemodynamic monitoring over 48-72 hours. Hemodynamic parameters including heart rate, blood pressure, and PI were systematically recorded. Statistical and Receiver operating characteristic curve analyses were used to assess the relationship between PI and shock.

Neonates experiencing shock exhibited significantly lower PI values than those without (P < 0.05). ROC curve analysis identified a PI threshold of 0.7 for predicting shock, demonstrating a high sensitivity (92.5%) and specificity (94.78%). Additionally, a significant association was observed between PI and serum lactate level (p < 0.05), underscoring the utility of PI as a predictor of shock severity.

The study suggests that a PI < 0.7 may serve as an indicator of circulatory shock in neonates, offers good sensitivity and specificity. The PI, along with clinical parameters and serum lactate levels, is a valuable tool for early shock identification in neonatal intensive care. Further research, including multicenter studies, are warranted to validate these findings.