Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction

Acta Paediatr. 2007 Oct;96(10):1455-9. doi: 10.1111/j.1651-2227.2007.00439.x. Epub 2007 Aug 28.


Aim: 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.

Design: We conducted a case-control study.

Setting: Our study population comprised 10,000 prospectively recruited newborns from Västra Götaland, Sweden.

Patients: 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).

Conclusion: 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case-Control Studies
  • Female
  • Health Status Indicators
  • Heart Defects, Congenital / diagnosis*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mass Screening*
  • Myocardial Reperfusion*
  • Myocardium*
  • Oximetry
  • Reference Values
  • Sweden
  • Time Factors