title: Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction.
abstract: OBJECTIVE
  Peripheral perfusion index (PPI) has been suggested as a possible method to detect illness causing circulatory embarrassment. We aimed to establish the normal range of this index in healthy newborns, and compare it with newborns with duct-dependent systemic circulation.
  
  
  METHODS
  We conducted a case-control study.
  
  
  METHODS
  Our study population comprised 10,000 prospectively recruited newborns from Västra Götaland, Sweden.
  
  
  METHODS
  A total of 10,000 normal newborns and 9 infants with duct-dependent systemic circulation (left heart obstructive disease [LHOD] group) participated in the study.
  
  
  METHODS
  We conducted single pre- and postductal measurements of PPI with a new generation pulse oximeter (Masimo Radical SET) before discharge from hospital.
  
  
  RESULTS
  PPI values between 1 and 120 h of age show an asymmetrical, non-normal distribution with median PPI value of 1.70 and interquartile range of 1.18-2.50. The 5th percentile = 0.70 and 95th percentile = 4.50. All infants in the LHOD group had either pre- or postductal PPI below the interquartile range, and 5 of 9 (56%) were below the 5th percentile cut-off of 0.70 (p < 0.0001, Fisher's exact test). A PPI value <0.70 gave an odds ratio for LHOD of 23.75 (95% CI 6.36-88.74).
  
  
  CONCLUSIONS
  PPI values lower than 0.70 may indicate illness and a value <0.50 (1st percentile) indicates definite underperfusion. PPI values might be a useful additional tool for early detection of LHOD.
authors.affiliation: Department of Paediatrics, The Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Sweden.
authors.forename: A de-Wahl
authors.initials: Ad
authors.lastname: Granelli
authors.forename: I
authors.initials: I
authors.lastname: Ostman-Smith
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006305:Health Status Indicators; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D015425:Myocardial Reperfusion; D009206:Myocardium; D010092:Oximetry; D012016:Reference Values; D013548:Sweden; D013997:Time Factors