Early postnatal perfusion index changes in term newborns
with subclinical chorioamnionitis
Claudio De Felice 1, Antonio Del Vecchio 2, Mario Criscuolo 3, Antonia Lozupone 3, Stefano Parrini 4 and Giuseppe Latini 5*
1 Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
2 Division of Neonatology, Perrino Hospital, Brindisi, Italy
3 Pathology Unit, Perrino Hospital, Brindisi, Italy
4 Department of Odontostomatology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
5 Division of Neonatology, Perrino Hospital, Italy
* To whom correspondence should be addressed. E-mail: gilatini{at}tin.it.
Accepted 17 February 2005
 | Abstract |
|---|
Background:Chorioamnionitis (HCA) at term
gestation is frequently subclinical and linked to
neonatal morbidity and mortality. We tested the value of
pulse oximetry perfusion index (PI) in early prediction
of subclinical HCA in term newborns.
Methods:PI cut-off values were first identified
in 51 HCA term newborns and 115 matched controls,
retrospectively categorised on the basis of placental
histology (study phase 1). The obtained PI thresholds
were subsequently tested on an unselected cases series
of 329 prospectively recruited, term newborns (study
phase 2). PI was evaluated during the first 5 minutes
after delivery. Initial illness severity and short-term
clinical outcomes were determined.
Results:In the study phase 1, HCA newborns showed
lower PI values at 1 and 5 minutes (p<0.0001) after
delivery, lower 1 minute Apgar score (p=0.017), lower
cord blood base excess (p=0.0001), together with higher
proportions of NICU admissions (p=0.0001), endotracheal
intubation (p=0.017), SNAP-PE (p<0.0001) and higher
NTISS (p<0.0001) score values than the HCA-negative
infants. In the prospective validation phase of the
study, the generated PI cut-off values (1-min PI
1.74, 5-min PI 2.18) showed 100% sensitivity, 99.4%
specificity, 93.7% positive predictive value, and 100%
negative predictive value in identifying subclinical
HCA. An early identification of HCA was associated to a
decreased admission rate to the NICU (p=0.012), as well
as lower initial illness severity (p0.0001) and
therapeutic intensity (p=0.0006) than the HCA newborns
of the study phase 1.
Conclusion:These findings suggest that an early
PI monitoring is helpful in identifying HCA in term
newborns.
Keywords:
Apgar score, Chorioamnionitis/diagnosis, Placenta diseases, Pulse oximetry
