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

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