Reference Values of Peripheral Perfusion Index in Healthy Neonates and Preliminary Observations of Congenital Heart Disease in Tibet: A Cohort Study

Q: What are the key findings of this study?

In healthy neonates born at high altitude, the peripheral perfusion index increased progressively over the first 72 hours postpartum, with lower-limb values consistently higher than upper-limb values.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy neonates and congenital heart disease (n=1043). Intervention: Postnatal age and measurement site vs. Baseline (6 hours) and upper limb. Primary outcome: Peripheral perfusion index (PPI) reference values and dynamic changes over 72 hours (p=<0.001).

Q: What does this research mean for the field?

In neonates born at high altitudes, the peripheral perfusion index increases progressively over the first 72 hours of life and is significantly lower in infants with congenital heart disease between 12 and 48 hours. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To establish dynamic, percentile-based reference curves for the peripheral perfusion index (PPI) in healthy neonates during the first 6 to 72 hours of life at high altitude, and to preliminarily characterize PPI patterns in infants with congenital heart disease.

Miaomiao Wei; Yaoyao Dong; Ciren Zhuoma; Lin Peng; Youping Tian; Qing Gu; Sheng Wei; Bianba Zhuoma; Xiaojing Hu; Guoying Huang

doi:10.3390/ijns12030054

July 20, 2026International Journal of Neonatal ScreeningOpen Access

Reference Values of Peripheral Perfusion Index in Healthy Neonates and Preliminary Observations of Congenital Heart Disease in Tibet: A Cohort Study

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Key result

Neonatal peripheral perfusion index rises progressively over the first 72 hours at high altitude.

P<0.001
n=1,043

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Why the study?

Reference values for peripheral perfusion index (PPI) at different postnatal time points in healthy neonates at high altitudes, and early perfusion characteristics in infants with congenital heart disease (CHD) in these settings, remain inadequately defined.

Does the peripheral perfusion index (PPI) differ between healthy neonates and those with congenital heart disease at high altitudes during the first 72 hours of life?

Key Points

To establish dynamic, percentile-based reference curves for the peripheral perfusion index (PPI) in healthy neonates during the first 6 to 72 hours of life at high altitude, and to preliminarily characterize PPI patterns in infants with congenital heart disease.
Conducted a longitudinal cohort study of 1043 consecutively born neonates (1034 healthy, 9 with congenital heart disease) at an altitude of 3650 m in Tibet.
Measured pre-ductal (right hand) and post-ductal (either foot) PPI at approximately 6, 12, 24, 48, and 72 hours postnatally.
Modeled percentile curves using Generalized Additive Models for Location, Scale and Shape (GAMLSS) and assessed site, time, and intergroup variations using Generalized Estimating Equations (GEE).
In healthy neonates, the 50th percentile (P50) upper-limb PPI rose from 2.32 at 6 hours to 2.77 at 72 hours, while lower-limb P50 rose from 2.53 to 2.90; lower-limb values were significantly higher than upper-limb values across all time points (p < 0.001).
PPI values in healthy neonates increased rapidly between 6 and 24 hours, slowed from 24 to 48 hours, and stabilized between 48 and 72 hours.
Compared to healthy neonates, infants with congenital heart disease exhibited significantly lower PPI values between 12 and 48 hours (p < 0.05), whereas values did not differ significantly at 6 hours (p = 0.0996) or at 72 hours (2.46 ± 0.09 vs. 2.79 ± 0.03, p = 0.0706).

Study Design

Type

Cohort (n=1,043)

Multicenter

No

Structured PICO

Does the peripheral perfusion index (PPI) differ between healthy neonates and those with congenital heart disease at high altitudes during the first 72 hours of life?

P

Population

1,043 neonates (1,034 healthy and 9 with congenital heart disease) born at high altitude (≥34 weeks gestation), followed for 72 hours postpartum to establish peripheral perfusion index reference values.

E

Exposure

Measurement of Peripheral Perfusion Index (PPI) using pulse oximetry at 6, 12, 24, 48, and 72 hours after birth

C

Comparator

Healthy neonates (for the congenital heart disease comparison arm)

O

Outcome

Dynamic changes and percentile-based reference values of the peripheral perfusion index (PPI) in healthy neonates during the first 6-72 hours after birthsurrogate

Main Result

p-value: p=<0.001

This study establishes high-altitude-specific normative reference curves for the peripheral perfusion index in healthy neonates and suggests it may be lower in those with congenital heart disease between 12 and 48 hours of life.

Limitations

Exclusion of neonates with gestational age <34 weeks and low birth weight
Predominantly Tibetan population, uncertain generalizability to other ethnicities
Exclusion of unstable neonates requiring respiratory support
Very small sample size of CHD neonates (n=9) with mostly mild lesions
Single-center study at a fixed high altitude
Exclusion of neonates with a gestational age below 34 weeks and low birth weight
Predominantly Tibetan population limits generalizability to other ethnicities
Exclusion of unstable neonates requiring respiratory support or hemodynamic intervention
Single-center cohort at a fixed high-altitude site

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Implication

Establishes high-altitude PPI reference values in healthy neonates; extends low-altitude data while leaving CHD screening role hypothesis-generating.

Abstract

The peripheral perfusion index (PPI) is a non-invasive indicator of peripheral tissue perfusion in neonates. However, reference values for the PPI at different postnatal time points in healthy neonates residing at high altitudes, as well as early perfusion characteristics in infants with congenital heart disease (CHD) in these settings, remain inadequately defined. The primary aim was to determine the dynamic changes in and percentile-based reference values of the PPI in healthy neonates during the first 6–72 h after birth in the high-altitude region of Tibet. A secondary, exploratory aim was to observe PPI patterns in neonates with CHD born during the same period and to compare the two groups, given the limited number of CHD cases enrolled. A longitudinal cohort study was conducted among consecutively born neonates in a high-altitude region of Tibet. The PPI was measured in the right hand (pre-ductal) and either foot (post-ductal) at 6, ~12, ~24, ~48, and ~72 h after birth. Generalized Additive Models for Location, Scale and Shape (GAMLSS) were used to construct percentile reference curves for healthy neonates. Generalized Estimating Equations (GEE) were applied to evaluate differences in the PPI across time points, measurement sites, and between groups (healthy vs. CHD). A total of 1043 neonates were enrolled, including 1034 in the healthy group and only 9 CHD cases. In healthy neonates, the PPI increased progressively within the first 72 h, with a rapid rise from 6 to 24 h, a slower increase from 24 to 48 h, and stabilization between 48 and 72 h. At all time points, the lower-limb PPI was significantly higher than the upper-limb PPI (p < 0.001). The 50th percentile (P50) values for the upper-limb PPI at 6, 12, 24, 48, and 72 h were 2.32, 2.46, 2.62, 2.63, and 2.77, respectively; corresponding values for the lower-limb PPI were 2.53, 2.64, 2.76, 2.77, and 2.90. Compared to the healthy group, neonates with CHD at high altitudes had similar PPI at 6 h. However, their PPI was significantly lower between 12 and 48 h. At 72 h, no statistically significant difference was found between the groups, likely due to the small sample size of CHD infants. Conclusions: This study provides a reference for routine perfusion assessment in stable neonates born at high altitudes. Due to the limited sample size (only 9 CHD cases), our findings on PPI changes in neonates with CHD remain preliminary. The normative PPI percentile curves established in this study offer objective baseline perfusion data for stable neonates living in high-altitude areas. Future large-scale cohort studies are still needed to validate the clinical value of the PPI as a perfusion monitoring tool in infants with CHD.

Discussion

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Cite This Study

Wei et al. (2026) conducted a cohort in Healthy neonates and congenital heart disease (n=1,043). Postnatal age and measurement site vs. Baseline (6 hours) and upper limb was evaluated on Peripheral perfusion index (PPI) reference values and dynamic changes over 72 hours (p=<0.001). In healthy neonates born at high altitude, the peripheral perfusion index increased progressively over the first 72 hours postpartum, with lower-limb values consistently higher than upper-limb values.

synapsesocial.com/papers/6a605e5b4163e025518d80e1 https://doi.org/10.3390/ijns12030054

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Reference Values of Peripheral Perfusion Index in Healthy Neonates and Preliminary Observations of Congenital Heart Disease in Tibet: A Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Reference Values of Peripheral Perfusion Index in Healthy Neonates and Preliminary Observations of Congenital Heart Disease in Tibet: A Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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