Capillary Refill Time in the Hands and Feet of Normal Newborn Infants

Abstract

We measured capillary refill time (CRT) in a convenience sample of 137 healthy newborns between 1 and 120 hours of age and 36-42 weeks gestation in the well-baby nursery of a large community hospital. CRT was measured by applying moderate pressure to the dorsum of the right hand and right foot for 5 seconds. Pressure was released and the time for complete refilling of the blanched area noted. Each infant was studied only once. We also measured ambient temperature and the skin temperature of the dorsum of the hand and foot and tested interobserver agreement. Mean CRT was 4.23±1.47 s (SD) (range 1.63-8.78 s) in the hand and 4.64±1.41 s (range 2.15-9.94 s) in the foot (p=0.0001) and did not change significantly in the first 72 hours. CRT decreased with increasing temperature. Environmental temperature, axillary temperature, and temperature of the hand and foot were all significantly and indirectly related to CRT, the strongest relationship existing between CRT and the skin temperature of the hand (r=-0.59, 95% CI 0.69, 0.47 p<0.00001) and foot (r=-0.33, 95% CI 0.46, 0.16 p<0.0001). With triplicate measurements, there was a statistically significant, but clinically moderate, order effect, CRT decreasing with each successive measurement (p<0.0001). Interobserver agreement was fair, the correlation coefficient (r) ranged from 0.47 to 0.71. We conclude that CRT as measured in the hand or foot of a newborn infant in the first 5 days of life is a relatively subjective measurement with an endpoint that is not easy to define and a wide range of values in normal infants. It is influenced significantly by environmental, axillary, and skin temperatures. Since there is no accepted standard for measuring decreased perfusion in the newborn, it is impossible to document the clinical utility of CRT in this population. Further studies are necessary before CRT can be accepted as a useful measure of peripheral perfusion and circulatory status in the newborn infant.

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References

1. Schriger DL , Baraff L . Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med. 1988;17:932-935.

2. Saavedra JM , Harris GD , Li S , Finberg L . Capillary refilling (skin turgor) in the assessment of dehydration. Am J Dis Child. 1991;145:296-298.

3. Gorelick H , Shaw N , Baker D . Effect of ambient temperature on capillary refill in healthy children. Pediatrics. 1993;92:699-702.

4. Baraff LJ . Capillary refill: Is it a useful clinical sign? Pediatrics. 1993;92:723-724.

5. Strozik KS , Pieper CH , Roller J . Capillary refill time in newborn babies; normal values. Arch Dis Child. 1997; 76:F193-F196.

6. Schriger DL , Baraff LJ . Capillary Re-fill–Is it a useful predictor of hypovolemic states? Ann Emerg Med. 1991; 20:601-605.

7. Sackett DL , Haynes RB , Tugwell P . Clinical Epidemiology-A Basic Science for Clinical Medicine. Toronto: Little Brown and Co; 1985.

8. Norman M , Fargell B , Herin P . Effects of neonatal polycythemia and hemodilution on capillary perfusion. J Pediatr. 1992;121:103-108.

9. Johnson JM , Brengelmann GL , Hales JRS , et al. Regulation of the cutaneous circulation. Fed Proc. 1986;45:2841-2850.

10.

10. Spealman CR . Effect of ambient air temperature and of hand temperature on blood flow in hands. Am J Physiol. 1945;145:218-222.

11.

11. Levick JR , Michel CC . The effects of position and skin temperature on the capillary pressures in the fingers and toes. J Physiol (London). 1978;274:97-109.

12.

12. Landis EM , Gibbon JH Jr . The effects of temperature and of tissue pressure on the movement of fluid through the human capillary wall. J Clin Invest. 1993;12:105-138.