None, N. N., None, Y. K. & None, G. K. (2025). Association between Peripheral Perfusion Index and Body Temperature in Critically Ill Children and Adolescents. Journal of Contemporary Clinical Practice, 11(8), 757-760.
MLA
None, Naina N., Yograj K. and Gunjana K. . "Association between Peripheral Perfusion Index and Body Temperature in Critically Ill Children and Adolescents." Journal of Contemporary Clinical Practice 11.8 (2025): 757-760.
Chicago
None, Naina N., Yograj K. and Gunjana K. . "Association between Peripheral Perfusion Index and Body Temperature in Critically Ill Children and Adolescents." Journal of Contemporary Clinical Practice 11, no. 8 (2025): 757-760.
Harvard
None, N. N., None, Y. K. and None, G. K. (2025) 'Association between Peripheral Perfusion Index and Body Temperature in Critically Ill Children and Adolescents' Journal of Contemporary Clinical Practice 11(8), pp. 757-760.
Vancouver
Naina NN, Yograj YK, Gunjana GK. Association between Peripheral Perfusion Index and Body Temperature in Critically Ill Children and Adolescents. Journal of Contemporary Clinical Practice. 2025 Aug;11(8):757-760.
Background: The Peripheral Perfusion Index (PPI) is a non-invasive marker of peripheral circulation, increasingly recognized for its utility in pediatric critical care. Body temperature, a vital sign reflecting systemic and peripheral hemodynamics, may influence PPI through thermoregulatory vascular responses.
Objectives:1. To record PPI and body temperature in critically ill children and adolescents.2. To analyze the correlation between PPI and body temperature across pediatric age groups. Methods: A prospective observational study was conducted in a tertiary care pediatric intensive care unit. Critically ill children and adolescents aged 1 month to 18 years were enrolled. PPI was measured using pulse oximetry, and body temperature was recorded via digital axillary thermometry (with correction for core temperature). Pearson’s correlation was used to assess the relationship between PPI and temperature in five age groups. Results: The study included 160 subjects. A statistically significant negative correlation between PPI and temperature was observed in the 5–12 years age group (r = –0.26, p = 0.044). Other age groups showed non-significant correlations. These findings suggest an age-dependent inverse relationship between peripheral perfusion and temperature.
Conclusion: In critically ill children, particularly those aged 5–12 years, higher body temperature is associated with lower PPI, likely reflecting thermoregulatory vasoconstriction. This relationship should be considered when interpreting PPI trends in pediatric critical care.
Keywords
Peripheral Perfusion Index (PPI)
Body temperature
Critically ill children
Pediatric intensive care
Thermoregulatory vasoconstriction
Pulse oximetry
Age-dependent correlation
Fever effects
Hemodynamic monitoring
School-aged children.
INTRODUCTION
Peripheral Perfusion Index (PPI), derived from the photoplethysmographic signal of pulse oximeters, quantifies the ratio of pulsatile to non-pulsatile blood flow, thus reflecting peripheral vascular tone and microcirculatory function (Allen et al., 2007[1]; Hasanin et al., 2017[2]). PPI is valued for its non-invasive, continuous, and real-time assessment of peripheral perfusion, especially in pediatric intensive care settings where early detection of circulatory compromise is critical (Sivaprasath et al., 2019[3]; Keles et al., 2022[4]).
Body temperature is a fundamental physiological parameter influencing cardiovascular and peripheral vascular responses. Fever and hypothermia can induce significant changes in vascular tone, affecting peripheral perfusion (Severinghaus et al., 2005[5]). The interplay between temperature and PPI remains underexplored in pediatric critical illness, where developmental differences in thermoregulation and vascular reactivity may alter this relationship (Kliegman et al., 2024[6]; Bjorklund et al., 2023[7]).
This study aims to record PPI and body temperature in critically ill children and adolescents and to analyze their correlation across age groups.
MATERIALS AND METHODS
A prospective observational study was conducted over 18 months in a tertiary care pediatric intensive care unit. Inclusion criteria were critically ill children and adolescents aged 1 month to 18 years. Exclusion criteria included congenital heart disease, peripheral vascular disease, limb anomalies, poor signal pickup, or early mortality.
Measurements
• PPI: Measured using Nellcor OxiMax pulse oximetry, continuously recorded at the finger or toe.
• Temperature: Recorded via digital axillary thermometer; corrected to core temperature by adding 1.87°F (Fouzas et al., 2011[8]).
• Other parameters: Demographic and clinical data were collected.
Statistical Analysis
Pearson’s correlation coefficient was used to assess the relationship between PPI and temperature in five age groups: 1 month–1 year, 1–3 years, 3–5 years, 5–12 years, and 12–18 years. Statistical significance was set at p < 0.05.
RESULTS
Demographics Of 160 enrolled subjects, the largest subgroup was 12–18 years (38.1%), followed by 5–12 years (28.1%). Males comprised 56.3% of the cohort. Correlation between PPI and Temperature
Table 1: Correlation between PPI and Temperature by Age Group
Age Group Temperature (Mean ± SD, °F) PPI (Mean ± SD) Pearson r p-value
1 mo–1 yr 100.12 ± 1.89 1.56 ± 0.77 –0.25 0.69
1–3 yrs 100.43 ± 1.64 2.13 ± 1.03 +0.19 0.355
3–5 yrs 99.87 ± 1.55 1.71 ± 0.72 –0.26 0.251
5–12 yrs 100.28 ± 1.71 2.22 ± 0.98 –0.26 0.044*
12–18 yrs 99.94 ± 1.43 1.85 ± 0.59 +0.01 0.934
*Statistically significant (p < 0.05)
A statistically significant moderate negative correlation was observed between PPI and temperature in the 5–12 years group (r = –0.26, p = 0.044), suggesting that as temperature rises, peripheral perfusion decreases in this age range. Other age groups did not show statistically significant correlations.
DISCUSSION
This study demonstrates an age-dependent relationship between body temperature and peripheral perfusion index in critically ill children and adolescents. The significant negative correlation in the 5–12 years group aligns with the physiological expectation that fever induces sympathetic-mediated peripheral vasoconstriction, thereby reducing PPI (Severinghaus et al., 2005[5]; Hasanin et al., 2017[2]).
The absence of significant correlations in other age groups may reflect developmental differences in autonomic regulation and vascular reactivity (Kliegman et al., 2024[6]; Bjorklund et al., 2023[7]). In infants and adolescents, thermoregulatory and cardiovascular responses may be less tightly coupled, or confounded by other factors such as hormonal changes and baseline vascular tone (Allen et al., 2007[1]; Al-Beltagi et al., 2024[9]).
These findings are clinically relevant as PPI is increasingly used for early detection of shock and monitoring of hemodynamic status in pediatric critical care (Sivaprasath et al., 2019[3]; Keles et al., 2022[4]). Interpreting PPI trends in the context of concurrent fever or hypothermia is essential, particularly in school-aged children, to avoid misattributing physiologic vasoconstriction to pathologic hypoperfusion.
Limitations:
• Cross-sectional correlation does not capture dynamic changes.
• External factors (ambient temperature, medications) may influence both PPI and temperature.
• Single-center design may limit generalizability.
CONCLUSION
In critically ill pediatric patients, especially those aged 5–12 years, body temperature is inversely correlated with peripheral perfusion index. This relationship likely reflects physiologic vasoconstriction in response to fever. Clinicians should consider temperature effects when interpreting PPI in pediatric intensive care.
REFERENCES
1. Kliegman RM, Stanton BF, St Geme JW, Schor NF. Nelson Textbook of Pediatrics. 1st South Asia Edition. Elsevier; 2024.
2. Mtaweh S, Kochanek PM, Bell MJ. Advances in Monitoring and Management of Shock. Pediatr Clin North Am. 2013;60(3):641–654.
3. Singh D, Singh S, Singh M, et al. A Clinical Profile of Shock in Children in Punjab, India. Indian Pediatr. 2006;43(2):129–135.
4. Saini SK, Kumar D, Saini S, et al. Predictors of Mortality in Neonatal Shock. Shock. 2022;57(1):60–66.
5. Bjorklund A, Suresh S, Kanwal S. Pediatric Shock Review. Pediatrics in Review. 2023;44(6):295–308.
6. Vincent JL, De Backer D. Circulatory Shock. N Engl J Med. 2013;369(18):1726–1734.
7. Allen J, Murray A. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007;28(3):R1–R39.
8. Sinex JE. Pulse oximetry: principles and limitations. Am J Emerg Med. 1999;17(1):59–66.
9. Levrat Q, Bouzat P, Beydon L, et al. Utility of Signal Extraction Technology-enabled pulse oximetry in ICU. Ann Fr Anesth Reanim. 2009;28(12):1011–1017.
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