Changeand And Significance Of The Early Neonatal Perfusion Index Of NICU

BackgroundRespiratory and circulatory diseases are the main causes of life-threatening of newborn.In recent years,the diagnosis and treatment level of neonatal respiratory diseases has been greatly improved,and the problems of circulatory system have gradually become the main cause of death.When blood pressure,heart rate and other traditional indexes of monitoring circulation change,the disease often gets to irretrievability.We need a monitoring method for early reaction cycle changes.Pulse perfusion index?PI?is a new measurement parameter of the new generation of pulse oximeter,and as a noninvasive monitoring tool for continuous evaluation of tissue perfusion and capacity status,it has important value in critical care,anesthesia surgery and so on.ObjectiveTo explore the changes and significance of PI in early neonate,whether PI can detect the changes of neonatal circulation early and whether PI can predict the severity of neonatal diseases.MethodFrom October 2018 to July 2019,124 newborns admitted to NICU of Xinxiang central hospital were admitted to the hospital within 24 hours after birth,6 of them were excluded from congenital malformation and genetic metabolic disease,and 118 children were included.After admission,the critical illness score of the newborn was given every day.If the score was more than 90,it was non critical.If the score was between 70-90,it was critical.If the score was less than 70,it was extremely critical.There were 502 times of PI monitoring,including 341 times of non critical cases,110 times of critical cases and51 times of extremely critical cases.According to the gestational age,the children who were not in critical condition within 7 days after birth were divided into two groups:term infants group and preterm infants group.The PI value of all the newborns was monitored in the quiet state on the 1st,2nd,3rd,4th,5th,6th and 7th day after birth.The pulse oximeter was Masimo radical-7 SPO₂.According to the neonatal critical illness score?NCIS?,invasive blood pressure monitoring was carried out with the consent and signature of the family members in critical and extremely critical cases.Mean arterial pressure?MAP?was recorded and blood lactate value and PI value were monitored at the same time.A total of 54 groups of data were collected.Results1.The PI value of the first day and the second day after the birth of term infants?20cases?and preterm infants?22 cases?was significantly different?P<0.05?.The PI values of the term group and the preterm group increased gradually from 1 to 7 days after birth.2.The comparison between PI and MAP,r value was 0.724,P<0.01,suggesting that there was a moderate positive correlation between PI and MAP;the comparison between PI and blood lactate,r value was-0.688,P<0.01,suggesting that there was a moderate negative correlation between PI and blood lactate;PI was no correlation with heart rate,SPO₂ and left ventricular ejection fraction?EF?.3.ROC curve analysis between PI and MAP shows that the cutoff point is 0.67 and the sensitivity is 87.8%,specificity 76.9%,AUC 0.872,P?0.01?4.The ROC curve between PI and blood lactate showed that the cutoff point was 1.35and the sensitivity was 100%,specificity 77.3%,AUC 0.931,P?0.01?5.The PI mean of non critical recombination?341 cases?was 2.21±1.08,the PI mean of critical recombination?110 cases?was 1.21±0.76,the PI mean of extremely critical recombination?51 cases?was 0.77±0.48,the PI value of three groups was analyzed by variance,P<0.01,the difference was statistically significant.PI mean of non critical recombination was higher than that of critical recombination.ConclusionPI is affected by gestational age,PI value of preterm infants is lower than that of full-term infants in the first two days after birth;PI is a sensitive index for monitoring circulation;PI can reflect the severity of neonatal disease,the lower PI value,the more serious the disease.