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Kazmi SH, Verma S, Bailey SM, Mally P, Desai P. Changes in regional tissue oxygen saturation values during the first week of life in stable preterm infants. J Perinat Med 2024; 52:445-451. [PMID: 38436066 DOI: 10.1515/jpm-2023-0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Near infrared spectroscopy (NIRS) is a non-invasive method for monitoring regional tissue oxygen saturation (rSO2). The purpose of this study is to investigate the changes that occur in cerebral, splanchnic, and renal rSO2 and fractional tissue oxygen extraction (FTOE) in stable preterm infants in the first week of life. METHODS Prospective observational study of infants born 30-34 weeks gestation at NYU Langone Health between November 2017 and November 2018. Cerebral, renal, and splanchnic rSO2 were monitored from 12 to 72 h of life, and at seven days. Subjects were divided into gestational age (GA) cohorts. Average rSO2, splanchnic cerebral oxygen ratio (SCOR), FTOE, and regional intra-subject variability was calculated at each location at five different time intervals: 0-12 h, 12-24 h, 24-48 h, 48-72 h, and one week of life. RESULTS Twenty subjects were enrolled. The average cerebral rSO2 ranged from 76.8 to 92.8 %, renal rSO2 from 65.1 to 91.1 %, and splanchnic rSO2 from 36.1 to 76.3 %. The SCOR ranged from 0.45 to 0.94. The strongest correlation between the GA cohorts was in the cerebral region (R2=0.94) and weakest correlation was in the splanchnic region (R2=0.81). The FTOE increased in all three locations over time. Intra-subject variability was lowest in the cerebral region (1.3 % (±1.9)). CONCLUSIONS The cerebral region showed the strongest correlation between GA cohorts and lowest intra-subject variability, making it the most suitable for clinical use when monitoring for tissue hypoxia. Further studies are needed to further examine rSO2 in preterm infants.
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Affiliation(s)
- Sadaf H Kazmi
- Department of Pediatrics, Hassenfeld Children's Hospital of New York University Langone Health Center, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Sourabh Verma
- Department of Pediatrics, Hassenfeld Children's Hospital of New York University Langone Health Center, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Sean M Bailey
- Department of Pediatrics, Hassenfeld Children's Hospital of New York University Langone Health Center, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Pradeep Mally
- Department of Pediatrics, Hassenfeld Children's Hospital of New York University Langone Health Center, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Purnahamsi Desai
- Department of Pediatrics, Hassenfeld Children's Hospital of New York University Langone Health Center, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
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2
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Gulizuohere A, Nuerya R. [Application of near-infrared spectroscopy in the early identification of neonatal gastrointestinal diseases]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:523-528. [PMID: 38802915 DOI: 10.7499/j.issn.1008-8830.2311148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal diseases in neonatal intensive care units, characterized by rapid progression and a high mortality rate. Local intestinal ischemia and hypoxia are significant contributors to NEC. Feeding intolerance (FI), which refers to a range of gastrointestinal manifestations arising from the inability to tolerate enteral nutrition, is one of the most common clinical issues in neonates, and preventing and treating FI is crucial for improving neonatal survival rates. Near-infrared spectroscopy is a clinical tool that can be used at the bedside to monitor regional oxygen saturation. It is non-invasive, reliable, and sustainable, and its feasibility and safety in assessing intestinal blood circulation have been validated. Early identification of intestinal ischemia and differentiation of FI from precursor symptoms of NEC, as well as predicting the occurrence of NEC, are extremely important for reducing intestinal injury and adverse long-term outcomes. In recent years, there has been new research progress related to the monitoring of intestinal tissue oxygen saturation and cerebral oxygen saturation for the early identification of FI and precursor symptoms of NEC, and this article provides a review of these developments.
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Affiliation(s)
- Alimujiang Gulizuohere
- Department of Neonatology, Children's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi 830063, China
| | - Rejiafu Nuerya
- Department of Neonatology, Children's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Medical University, Urumqi 830063, China
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Kooi EMW, Mintzer JP, Rhee CJ, Ergenekon E, Schwarz CE, Pichler G, de Boode WP. Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy : Part of the series on near-infrared spectroscopy by the European Society of Paediatric Research Special Interest Group "Near-Infrared Spectroscopy". Pediatr Res 2024:10.1038/s41390-024-03226-z. [PMID: 38730022 DOI: 10.1038/s41390-024-03226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
In this narrative review, we summarize the current knowledge and applications of somatic near-infrared spectroscopy (NIRS), with a focus on intestinal, renal, limb, and multi-site applications in neonates. Assessing somatic oxygenation at various body locations in neonates may aid in the understanding of underlying pathophysiology of organ injury. Considering cerebral autoregulation may be active to protect the brain during systemic circulatory failure, peripheral somatic oxygenation may potentially provide an early indication of neonatal cardiovascular failure and ultimate hypoxemic injury to vital organs including the brain. Certain intestinal oxygenation patterns appear to be associated with the onset and course of necrotizing enterocolitis, whereas impaired renal oxygenation may indicate the onset of acute kidney injury after various types of hypoxic events. Peripheral muscle oxygenation measured at a limb may be particularly effective in the early prediction of shock in neonates. Using multi-site NIRS may complement current approaches and clinical investigations to alert for neonatal tissue hypoxemia, and potentially even guide management. However, somatic NIRS has its inherent limitations in regard to accuracy. Interpretation of organ-specific values can also be challenging. Last, currently there are limited prospective intervention studies, and clinical benefits need to be examined further, after the clarification of critical threshold-values. IMPACT: The assessment of somatic oxygenation using NIRS may contribute to the prediction of specific diseases in hemodynamically challenged neonates. Furthermore, it may give early warning signs for impending cardiovascular failure, and impaired cerebral circulation and oxygenation. We present a comprehensive overview of the literature on applications of NIRS to various somatic areas, with a focus on its potential clinical applicability, including future research directions. This paper will enable prospective standardized studies, and multicenter collaboration to obtain statistical power, likely to advance the field.
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Affiliation(s)
- Elisabeth M W Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | | | | | - Christoph E Schwarz
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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4
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Ercan G, Imamoglu EY, Şahin Ö, Çolak D, Imamoglu S. Does Cerebral Oxygenation Change during Peripherally Inserted Central Catheterization in Preterm Infants? Am J Perinatol 2024; 41:e1330-e1336. [PMID: 36669756 DOI: 10.1055/a-2016-7502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of peripherally inserted central venous catheterization on cerebral oxygenation by near-infrared spectroscopy in very low birth weight preterm infants. STUDY DESIGN Forty-one preterm infants (gestational age ≤32 weeks and birth weight ≤1,500 g) requiring peripherally inserted central venous catheter were included. Hemodynamic data and cerebral regional oxygen saturation values measured by near-infrared spectroscopy were prospectively collected before (T0) and every 5 minutes for 30 minutes following catheterization. When compared with baseline (T0) values, those values having relative maximum changes in the first 15 minutes and between 15 and 30 minutes were defined as T15 max and T30 max, respectively. Any change of more than a 10% decrease in baseline cerebral rSO2 was considered clinically significant. Additionally, any changes exceeding 20% in heart rate and mean arterial blood pressure values were considered significant. Following catheterization, the time interval to reach the baseline for cerebral regional oxygen saturation was noted. RESULTS Cerebral regional oxygen saturation values at T15 max and T30 max were found to have decreased significantly in 46 and 22% of patients, respectively. A statistically significant difference was observed between these two time periods (p = 0.002); no significant differences in heart rate, mean arterial blood pressure, or cerebral fractional oxygen extraction values at T15 max and T30 max were observed. All patients reached their baseline cerebral regional oxygen saturation in a median of 25 (15-60) minutes. CONCLUSION In very low birth weight preterm infants, monitoring cerebral regional oxygen saturation by near-infrared spectroscopy before and after peripherally inserted central venous catheterization may be useful in clinical practice. The assessment of factors affecting cerebral oxygenation and, in the case of low cerebral oxygenation, implementation of corrective actions before peripherally inserted central catheterization may offer a neuroprotective strategy. KEY POINTS · Monitoring cerebral rSO2 by NIRS during PICC line procedure might be useful in preterm infants.. · In this study, a significant decrease in cerebral rSO2 level following catheterization was observed.. · Implementation of corrective actions before PICC line procedure may offer a neuroprotective strategy..
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Affiliation(s)
- Gözde Ercan
- Department of Pediatrics, Faculty of Health Sciences, Sancaktepe Prof Ilhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Ebru Y Imamoglu
- Department of Neonatology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özlem Şahin
- Department of Neonatology, Faculty of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Derya Çolak
- Department of Neonatology, Faculty of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serhat Imamoglu
- Department of Ophthalmology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Satar M, Erol AH, Özdemir M, Özbarlas N, Atmış A, Özlü F, Büyükkurt S. Influence of umbilical cord clamping time on cerebral oxygenation and early cardiac function in term infants. J Neonatal Perinatal Med 2024:NPM230223. [PMID: 38607769 DOI: 10.3233/npm-230223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Delayed cord clamping is the standard of care for both term and preterm infants worldwide. The aim of this study was to evaluate the effect of 60-second or 180-second delayed cord clamping during labor on cerebral oxygenation and cardiac function. METHODS Healthy newborns were divided into two groups: a 60-second delay in cord clamping (60-s DCC) and a 180-second delay in cord clamping (180-s DCC) at birth. Pulse oximetry and cerebral near-infrared spectroscopy (cNIRS) probes were placed during postnatal care. A total of 84 healthy newborns were included in this study. Preductal oxygen saturation (SpO2), heart rate, and cNIRS values were recorded at 5 and 10 minutes after delivery. The cardiac function of the infants was assessed by echocardiography at 3-7 days postnatally. RESULTS There was no significant difference between the groups in SpO2 and cNIRS values at 5 and 10 min. While there was no significant difference in the number of neonates with targeted SpO2 at the 5th and 10th min and targeted cNIRS values at the 10th min, there was a significant difference in the number of neonates with target cNIRS values at the 5th min between groups (p < 0.001). Echocardiographic findings showed that pulmonary flow velocity was increased in the 180-s DCC group; the difference was statistically significant (p = 0.04). CONCLUSION Our results showed that the number of infants with normal cNIRS values regarding cerebral oxygenation was higher in the 180-s DCC group. The pulmonary flow velocity was significantly increased in the 180-s DCC group in terms of echocardiographic findings.
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Affiliation(s)
- M Satar
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - A H Erol
- Department of Pediatrics, Faculty of Medicine Çukurova University, Adana, Turkey
| | - M Özdemir
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - N Özbarlas
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - A Atmış
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - F Özlü
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - S Büyükkurt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Strozzi C, Di Battista C, Graziosi A, D'Adamo E, Librandi M, Patacchiola R, Maconi A, Ghiglione V, Pelazzo C, Pasino M, Paterlini G, Bozzetti V, Salvo V, Gazzolo F, Concolino D, Abella L, Spinelli M, Betti M, Bertolotti M, Gazzolo D. Cerebral and systemic near infrared spectroscopy patterns in preterm infants treated by caffeine. Acta Paediatr 2024; 113:700-708. [PMID: 38156367 DOI: 10.1111/apa.17077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
AIM To investigate the effects of caffeine loading/maintenance administration on near-infrared spectroscopy cerebral, kidney and splanchnic patterns in preterm infants. METHODS We conducted a multicentre case-control prospective study in 40 preterm infants (gestational age 29 ± 2 weeks) where each case acted as its own control. A caffeine loading dose of 20 mg/kg and a maintenance dose of 5 mg/kg after 24 h were administered intravenously. Near infrared spectroscopy monitoring parameters were monitored 30 min before, 30 min during and 180 min after caffeine therapy administration. RESULTS A significant increase (p < 0.05) in splanchnic regional oxygenation and tissue function and a decrease (p < 0.05) in cerebral tissue function after loading dose was shown. A preferential hemodynamic redistribution from cerebral to splanchnic bloodstream was also observed. After caffeine maintenance dose regional oxygenation did not change in the monitored districts, while tissue function increased in kidney and splanchnic bloodstream. CONCLUSION Different caffeine administration modalities affect cerebral/systemic oxygenation status, tissue function and hemodynamic pattern in preterm infants. Future studies correlating near infrared spectroscopy parameters and caffeine therapy are needed to determine the short/long-term effect of caffeine in preterm infants.
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Affiliation(s)
- Chiara Strozzi
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | | | | | - Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Michela Librandi
- Department of Pediatrics, G. d'Annunzio University, Chieti, Italy
| | | | - Antonio Maconi
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Valeria Ghiglione
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Claudia Pelazzo
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Marta Pasino
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Valentina Bozzetti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Vincenzo Salvo
- Neonatal Intensive Care Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Francesca Gazzolo
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Daniela Concolino
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Martina Spinelli
- Department of Science and Technological Innovation, Piemonte Orientale University, Alessandria, Italy
| | - Marta Betti
- Integrated Activities Research Innovation Department, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Marinella Bertolotti
- Integrated Activities Research Innovation Department, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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Arriaga-Redondo M, Rodríguez-Sánchez de la Blanca A, Zunzunegui JL, Ballesteros-Tejerizo F, Rodríguez-Ogando A, González-Navarro P, Blanco-Bravo D, Sánchez-Luna M. Impact of catheterized ductal closure on renal and cerebral oximetry in premature neonates. Eur J Pediatr 2024:10.1007/s00431-024-05541-3. [PMID: 38558310 DOI: 10.1007/s00431-024-05541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Percutaneous catheter-based closure is increasingly utilized in premature newborns. While near-infrared spectroscopy (NIRS) has been examined for assessment of interventional closure in surgical ligation, its application in percutaneous transcatheter closure remains unexplored. This study aims to assess cerebral and renal hemodynamic changes using NIRS during percutaneous closure compared to surgical closure in preterm infants. A prospective observational study enrolled preterm infants born at 32 weeks of gestation or less and diagnosed with hsPDA between January 2020 and December 2022. These infants received either surgical or catheter-based closure of the PDA. Cerebral and renal oxygen saturation was monitored using the INVOS 5100 device from 12 h before the intervention until 24 h after. Linear mixed-effects models were used to analyze time-dependent variables. Twenty-two patients were enrolled, with catheter-based closure performed in 16 cases and conventional surgery in 6 cases. Following ductal closure, a significant increase in renal and cerebral oximetry was observed alongside a decrease in renal and cerebral tissue oxygen extraction. These changes were particularly pronounced in the renal territory. No differences were detected between catheterization and surgical closure. Conclusion: An improvement in cerebral and renal oximetry following hsPDA closure was observed. However, we did not identify differences in this pattern based on the type of interventional procedure for PDA, whether surgery or catheterization. What is Known: • The presence of a significant ductus is common in premature patients. Studies have shown that it affects cerebral and renal hemodynamics negatively, leading to decreased oximetry values in these areas. It has been reported that closure of the ductus, either pharmacologically or surgically, results in improved oximetry values. What is New: • This study assess the impact of percutaneous closure of ductus, revealing increased oximetry values in cerebral and renal territories without significant differences compared to surgical ligation. Notably, renal oximetry values showed a greater increase, underscoring the importance of multi-location monitoring.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain.
| | | | - José Luis Zunzunegui
- Pediatric Cardiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | - Pablo González-Navarro
- Unidad de Investigación Materno Infantil-Fundación Familia Alonso (UDIMIFFA)-Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Dorita Blanco-Bravo
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Gregorio Marañón University Hospital (HGU), C/Maiquez 9, Madrid, 28009, Spain
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Meng W, Wang Q, Xu Q, Gao H, Zhou Y, Shao W. Biomarkers in the Severity of Necrotizing Enterocolitis in Preterm Infants: A Pilot Study. Int J Gen Med 2024; 17:1017-1023. [PMID: 38505145 PMCID: PMC10950000 DOI: 10.2147/ijgm.s446378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background The occurrence of necrotizing enterocolitis (NEC) is a common and severe disease of the digestive system in neonates. This study aims to assess the value of the intestinal tissue oxygen saturation (rintSO2) combined with the levels of procalcitonin (PCT) and mean platelet volume (MPV) in predicting the severity of NEC in preterm infants. Methods This experiment was a retrospective cohort study conducted in the Department of Pediatrics, Hongqi Hospital Affiliated to Mudanjiang Medical University between January 2017 and July 2022. Premature neonates with NEC were enrolled and divided into mild-moderate NEC group and severe NEC group according to Bell's stage. The general information data, rintSO2 and blood parameters such as the white blood cell (WBC) count, platelet count (PLT), PCT, MPV, red blood cell distribution width (RDW), hemoglobin (Hb), C-reactive protein (CRP) were compared between the two groups. Results A total of 122 patients were enrolled, including 79 mild-moderate NEC and 43 severe NEC. The rintSO2 was lower in severe group than in mild-moderate group (P = 0.042), the PCT and MPV were both higher in severe group than in mild-moderate group (P = 0.048, P = 0.049). The results of logistic regression suggested that the rintSO2 (OR = 1.491, P = 0.003), PCT (OR = 3.071, P = 0.001) and MPV (OR = 4.027, P = 0.015) were independent predictive factors for severity of NEC. The area under the curve (AUC) of the rintSO2 combined with PCT and MPV showed good diagnostic ability in the severity of NEC. Conclusion The rintSO2 combined with PCT and MPV may be considered as the early biomarkers in the severity of NEC and could help us to diagnose the case early with early treatment with better prognosis.
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Affiliation(s)
- Wei Meng
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Qing Wang
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Qingyu Xu
- Department of Pediatrics Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People's Republic China
| | - Hongli Gao
- Department of Digestive Endoscopy Center, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Yunjun Zhou
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Wei Shao
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
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Savluk OF, Yilmaz AA, Yavuz Y, Arisut S, Ukil Isildak F, Turkmen Karaagac A, Ozbek B, Cine N, Tuncer E, Ceyran H. Assessment of microcirculatory alteration by a vascular occlusion test using near-infrared spectroscopy in pediatric cardiac surgery: effect of cardiopulmonary bypass. Expert Rev Med Devices 2024; 21:249-255. [PMID: 38217402 DOI: 10.1080/17434440.2024.2306155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Cardiopulmonary bypass cause microcirculatory alterations. Near infrared spectroscopic measurement of tissue oxygen saturation and vascular occlusion test are novel technologies for assessing the microcirculatory function of peripheral tissue specifically in patients undergoing cardiac surgery with cardiopulmonary bypass.Our study aimed to evaluate dynamic microcirculatory function using the vascular occlusion testing during cardiac surgery in pediatric patients. METHODS 120 pediatric patients were scheduled. Children had continuous regional oxygen saturation monitoring using near infrared spectroscopy and vascular occlusion test. Vascular occlusion test was performed five times; before induction (T1), after induction (T2), then during cardiopulmonary bypass with full flow (T3), after the termination of CPB (T4) and after sternum closure (T5). RESULTS Basal value was the lowest at T3 and this value was significantly different among measurements (p < 0,01).Values for maximum and minimum tissue oxygen saturation were the lowest at T3 (83,4 and 52,9%).The occlusion slope varied significantly among measurements (p < 0,01).Reperfusion slopes were significantly different among measurements (p < 0,01) with a further progressive decrease in reperfusion slope with duration of cardiopulmonary bypass. CONCLUSION Microcirculatory function can assessed using VOT with forearm Near-infrared spectroscopy derived variables during cardiopulmonary bypass in pediatric cardiac surgery. Noninvasive assessment of microcirculatory perfusion during cardiopulmonary bypass can further help evaluate and improve circulatory support techniques. TRIAL REGISTRATION The research Project was registered at ClinicalTrials.gov (NCT06191913).
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Affiliation(s)
- Omer Faruk Savluk
- Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Abdullah Arif Yilmaz
- Pediatric Cardiac Surgery Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Yasemin Yavuz
- Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Seda Arisut
- Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Fatma Ukil Isildak
- Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Aysu Turkmen Karaagac
- Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Baburhan Ozbek
- Pediatric Cardiac Surgery Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Nihat Cine
- Pediatric Cardiac Surgery Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Eylem Tuncer
- Pediatric Cardiac Surgery Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
| | - Hakan Ceyran
- Pediatric Cardiac Surgery Clinic, Kartal Kosuyolu High Education and Training Hospital, Istanbul, Turkey
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Marin T, Moore J. Understanding Near-Infrared Spectroscopy: An Update. Crit Care Nurs Clin North Am 2024; 36:41-50. [PMID: 38296375 DOI: 10.1016/j.cnc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Near-infrared spectroscopy (NIRS) is a novel technology that uses infrared light to noninvasively and continuously measure regional oxygen extraction in real time at the bedside. Neonatal research using this device supports its use as an adjunct to routine cardiovascular monitoring because NIRS serves as a surrogate marker for end-organ perfusion and can detect minute changes in cerebral, intestinal, and kidney tissue beds. Multiple conditions affecting premature infants are frequently associated with hypoperfusion; therefore, methods to detect early tissue-specific perfusion alterations may substantially improve the clinician's ability to intervene and prevent further deterioration.
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Affiliation(s)
- Terri Marin
- Department of Nursing Science, Augusta University, College of Nursing, 1120 15th Street, EC-4350, Augusta, GA 30912, USA.
| | - James Moore
- Department of Pediatrics, Division of Neonatology, University of Connecticut School of Medicine, 10 Columbus Boulevard, Hartford, CT 06106, USA
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Yücel A, Küçükoğlu S, Soylu H. The Effect of Breast Milk Odor on Feeding Cues, Transition Time to Oral Feeding, and Abdominal Perfusion in Premature Newborns: A Randomised Controlled Trial. Biol Res Nurs 2024; 26:160-175. [PMID: 37682253 DOI: 10.1177/10998004231200784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE The present study was conducted to determine the effect of odor stimulation with breast milk (BM) applied to premature newborns before and during enteral feeding on feeding cues, transition time to oral feeding and abdominal perfusion. DESIGN This study was a parallel group pretest-post test randomised controlled trial (RCT). METHODS The study was conducted in the neonatal intensive care unit (NICU) in Türkiye. Study data were collected from 32 premature newborns between October 2020 and December 2021. Newborns were randomly assigned to either intervention (n = 16) or control (n = 16) groups. Odor stimulation with BM was applied to newborns in the intervention group (IG) before and during enteral feeding for 3 days. Data were collected with the Newborn Information Form, Abdominal Perfusion Follow-up Form, and Feeding Cues Follow-up Form. Yates corrected and Fisher chi-squared test, Mann-Whitney U test, Cohen Kappa statistics, Permanova analysis, and Wilcoxon test were used in the analysis. The study was registered in ClinicalTrials.gov (NCT04843293). RESULTS The frequency of feeding cues in newborns who were exposed to the odor of BM, was higher than in the control group (CG) (p < .05). The transition times to oral feeding were similar in newborns in the IG and CG (p > .05). Abdominal perfusion level of newborns in the IG was higher than the CG (p < .05), and the level of abdominal perfusion showed a significant difference in terms of group*time interaction (p < .05). CONCLUSION Our findings suggest that odor stimulation with BM will be beneficial in improving the digestive functions of premature newborns.
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Affiliation(s)
- Adalet Yücel
- Department of Nursing, Faculty of Nursing, Selcuk University, Konya, Türkiye
| | - Sibel Küçükoğlu
- Department of Nursing, Faculty of Nursing, Selcuk University, Konya, Türkiye
| | - Hanifi Soylu
- Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya, Türkiye
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12
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Raets M, Dirix M, Hütten MC. Cerebral near-infrared spectroscopy for early recognition of impending cardiac tamponade in a preterm neonate. BMJ Case Rep 2023; 16:e256014. [PMID: 38087490 PMCID: PMC10728941 DOI: 10.1136/bcr-2023-256014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Cardiac tamponade is a rare but life-threatening complication of umbilical venous catheter (UVC) placement in neonates. Mortality rates are high; therefore, early diagnosis is important. We present a case of a preterm infant with a UVC in situ who underwent a laparotomy on the first day of life for pneumoperitoneum secondary to meconium ileus. The operation was uneventful; however, 2 hours after surgery, the patient developed cardiac tamponade, requiring resuscitation and pericardiocentesis. In retrospect, near-infrared spectroscopy (NIRS) showed a gradual decline in cerebral oxygenation (crSO2) in the 30 min prior to the cardiac arrest, while other vital signs were within normal ranges. Our case demonstrates that cerebral NIRS monitoring can serve as an additional clinical marker for early recognition of impending cardiac tamponade.
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Affiliation(s)
- Marlou Raets
- Pediatrics, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - Marc Dirix
- Surgery, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - Matthias Christian Hütten
- Pediatrics, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
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13
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Pellegrino C, Papacci P, Beccia F, Serrao F, Cantone GV, Cannetti G, Giannantonio C, Vento G, Teofili L. Differences in Cerebral Tissue Oxygenation in Preterm Neonates Receiving Adult or Cord Blood Red Blood Cell Transfusions. JAMA Netw Open 2023; 6:e2341643. [PMID: 37934499 PMCID: PMC10630897 DOI: 10.1001/jamanetworkopen.2023.41643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/24/2023] [Indexed: 11/08/2023] Open
Abstract
Importance Repeated transfusions in preterm neonates with anemia of prematurity replace fetal hemoglobin (HbF) with adult Hb (HbA), which has a low oxygen affinity. The reduction of HbF is associated with a higher incidence of retinopathy of prematurity (ROP). Objective To assess whether HbF and HbA are differently associated with cerebral tissue oxygenation in preterm neonates. Design, Setting, and Participants This cohort study was a single-center, pilot study on cerebral oxygenation kinetics in preterm neonates with a gestational age between 24.0 weeks and 27.9 weeks who were admitted to the neonatal intensive care unit of Policlinico Universitario A. Gemelli IRCCS from December 27, 2021, to May 15, 2023. This study was ancillary to the ongoing, double-blind, multicenter Umbilical or Adult Donor Red Blood Cells in Extremely Low Gestational Age Neonates and Retinopathy of Prematurity (BORN) randomized clinical trial. The BORN trial outcome was ROP severity in neonates randomized to receive standard packed red blood cell (PRBC) transfusions obtained from RBCs of adult donors (A-RBCs) or from cord blood (CB-RBCs). According to standard procedures at the institute's neonatal intensive care unit, patients concurrently received continuous cerebral near-infrared spectroscopy (NIRS) monitoring. This cohort study was not prespecified in the trial protocol. Exposure Transfusion with A-RBCs or CB-RBCs. Main Outcomes and Measures The main outcome was the kinetics of cerebral regional oxygen saturation (crSO2) and cerebral fraction of tissue oxygen extraction (cFTOE) associated with A-RBC or CB-RBC transfusions. Cerebral NIRS monitoring was performed by neonatologists and nurses, who were blinded to the PRBC type. The NIRS monitoring was conducted starting with the blood product order, during transfusion, and for the subsequent 24 hours after transfusion completion. The mean treatment effects of A-RBCs or CB-RBCs were quantified using a linear mixed model for repeated measures. Results Of 23 randomized neonates, 17 (11 male [64.7%]; median gestational age at birth, 25.6 weeks [IQR, 25.3-26.1 weeks]) with a median birth weight of 840 g (IQR, 580-900 g) were included in the study; NIRS was evaluated for 42 transfusion episodes, of which 22 were A-RBCs and 20 were CB-RBCs. Globally considering all posttransfusion time points, the overall crSO2 covariate-adjusted mean after CB-RBC transfusions was 5.27% lower (95% CI, 1.20%-9.34%; P = .01) than that after A-RBC transfusions, while the cFTOE after CB-RBC transfusions was 6.18% higher (95% CI, 1.66%-10.69%; P = .009) than that after A-RBCs. Conclusions and Relevance The findings of this cohort study suggest that A-RBC transfusions may be associated with more oxygen delivery to cerebral tissues of preterm neonates than transfusions from CB-RBCs. This finding may explain the previously observed association between low HbF and high ROP risk. It also suggests that use of CB to meet the RBC transfusion needs of neonates with a gestational age of less than 28 weeks may protect cerebral tissues from overexposure to oxygen.
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Affiliation(s)
- Claudio Pellegrino
- Department of Image, Radiation Therapy, Oncology and Hematology Diagnosis, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Roma, Italy
- Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Papacci
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Rome, Italy
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Beccia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Rome, Italy
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Serrao
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Rome, Italy
| | - Giulia Vanina Cantone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Rome, Italy
| | - Giorgio Cannetti
- Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmen Giannantonio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Rome, Italy
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luciana Teofili
- Department of Image, Radiation Therapy, Oncology and Hematology Diagnosis, Fondazione Policlinico Universitario A. Gemelli IRCCS, Hospitalization and Health Care, Roma, Italy
- Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Chiperi LE, Huţanu A, Tecar C, Muntean I. Serum Markers of Brain Injury in Pediatric Patients with Congenital Heart Defects Undergoing Cardiac Surgery: Diagnostic and Prognostic Role. Clin Pract 2023; 13:1253-1265. [PMID: 37887089 PMCID: PMC10605074 DOI: 10.3390/clinpract13050113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction: The objectives of this study were to assess the role of neuromarkers like glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF), protein S100 (pS100), and neuron-specific enolase (NSE) as diagnostic markers of acute brain injury and also as prognostic markers for short-term neurodevelopmental impairment. Methods: Pediatric patients with congenital heart defects (CHDs) undergoing elective cardiac surgery were included. Neurodevelopmental functioning was assessed preoperatively and 4-6 months postoperatively using the Denver Developmental Screening Test II. Blood samples were collected preoperatively and postoperatively. During surgery, regional cerebral tissue oxygen saturation was monitored using near-infrared spectroscopy (NIRS). Results: Forty-two patients were enrolled and dichotomized into cyanotic and non-cyanotic groups based on peripheric oxygen saturation. Nineteen patients (65.5%) had abnormal developmental scores in the non-cyanotic group and eleven (84.6%) in the cyanotic group. A good diagnostic model was observed between NIRS values and GFAP in the cyanotic CHD group (AUC = 0.7). A good predicting model was observed with GFAP and developmental scores in the cyanotic CHD group (AUC = 0.667). A correlation was found between NSE and developmental quotient scores (r = 0.09, p = 0.046). Conclusions: From all four neuromarkers studied, only GFAP was demonstrated to be a good diagnostic and prognostic factor in cyanotic CHD patients. NSE had only prognostic value.
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Affiliation(s)
- Lacramioara Eliza Chiperi
- Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Heart Transplant, 540136 Targu Mures, Romania
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Huţanu
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Laboratory of Humoral Immunology, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Cristina Tecar
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania
| | - Iolanda Muntean
- Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Heart Transplant, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Marin T, Ghosh S, Cockfield C, Mundy C, Mansuri A, Stansfield BK. Routine Diaper Change Alters Kidney Oxygenation in Premature Infants: A Non-A Priori Analysis. Adv Neonatal Care 2023; 23:450-456. [PMID: 37253178 DOI: 10.1097/anc.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. PURPOSE To describe changes in continuous kidney oxygenation (RrSO 2 ) measures before, during, and after routine diaper changes. METHODS Non-a priori analysis of a prospective cohort that received continuous measurement of RrSO 2 with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO 2 drops surrounding diaper changes. RESULTS In total, 26 of 38 (68%) infants (≤1800 g) from our cohort exhibited acute drops in RrSO 2 that temporally correlated with diaper changes. Mean (SD) RrSO 2 baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change ( P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery ( P < .001; 95% CI, -16.9 to -11.2). The mean decrease in RrSO 2 during diaper change averaged 12 points (17%) below 15-minute RrSO 2 mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO 2 , blood pressure, or heart rate were documented during the intermittent kidney hypoxic events. IMPLICATIONS FOR PRACTICE AND RESEARCH Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO 2 as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.
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Affiliation(s)
- Terri Marin
- Department of Nursing Science, College of Nursing (Dr Marin), Department of Biostatistics (Dr Ghosh), Division of Neonatology, Department of Pediatrics (Drs Cockfield, Mundy, and Stansfield), and Department of Pediatric Nephrology (Dr Mansuri), Medical College of Georgia, and Vascular Biology Center (Dr Stansfield), Augusta University, Augusta, Georgia
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16
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Palleri E, van der Heide M, Hulscher JBF, Bartocci M, Wester T, Kooi EMW. Clinical usefulness of splanchnic oxygenation in predicting necrotizing enterocolitis in extremely preterm infants: a cohort study. BMC Pediatr 2023; 23:336. [PMID: 37393233 PMCID: PMC10314466 DOI: 10.1186/s12887-023-04145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Impaired intestinal microcirculation seems to play an important role in the pathogenesis of necrotizing enterocolitis (NEC). A previous study showed that a SrSO2 < 30% is associated with an increased risk of developing of NEC. We aimed to determine the clinical usefulness of the cut off < 30% for SrSO2 in predicting NEC in extremely preterm neonates. METHODS This is a combined cohort observational study. We added a second cohort from another university hospital to the previous cohort of extremely preterm infants. SrSO2 was measured for 1-2 h at days 2-6 after birth. To determine clinical usefulness we assessed sensitivity, specificity, positive and negative predictive values for mean SrSO2 < 30. Odds ratio to develop NEC was assessed with generalized linear model analysis, adjusting for center. RESULTS We included 86 extremely preterm infants, median gestational age 26.3 weeks (range 23.0-27.9). Seventeen infants developed NEC. A mean SrSO2 < 30% was found in 70.5% of infants who developed NEC compared to 33.3% of those who did not (p = 0.01). Positive and negative predictive values were 0.33 CI (0.24-0.44) and 0.90 CI (0.83-0.96), respectively. The odds of developing NEC were 4.5 (95% CI 1.4-14.3) times higher in infants with SrSO2 < 30% compared to those with SrSO2 ≥ 30%. CONCLUSIONS A mean SrSO2 cut off ≥ 30% in extremely preterm infants between days 2-6 after birth may be useful in identifying infants who will not develop NEC.
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Affiliation(s)
- E Palleri
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - M van der Heide
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - J B F Hulscher
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Bartocci
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - T Wester
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E M W Kooi
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
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Surmeli Onay O, Velipasaoğlu M, Tutal M, Sarılar TD, Cakıl Saglık A, Bilgin M, Aydemir O, Barsan Kaya T, Tanır HM, Tekin AN. The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial. Eur J Pediatr 2023; 182:1317-1328. [PMID: 36637540 DOI: 10.1007/s00431-023-04810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants' fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without. Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation. Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495, https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist= . Retrospectively registered, date of registration: August 2022. What is Known: • It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation. What is New: • The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent). • In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.
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Affiliation(s)
- Ozge Surmeli Onay
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Melih Velipasaoğlu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Merve Tutal
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tevhide Derya Sarılar
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Adviye Cakıl Saglık
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozge Aydemir
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tugba Barsan Kaya
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Mete Tanır
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ayşe Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Hossain MS, Khan FA, Cass DL, Robertson JO. Discontinuation of the OriGen® Dual-lumen Right Atrial Cannula Decreased Venovenous ECMO Usage in Neonates and Older Children: A Survey of the American Pediatric Surgical Association. J Pediatr Surg 2023; 58:1185-1190. [PMID: 36914461 DOI: 10.1016/j.jpedsurg.2023.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Dual-lumen cannulas for venovenous (VV)-ECMO are widely used in pediatric patients. The popular OriGen® dual-lumen right atrial cannula was discontinued in 2019 without a comparable replacement. METHODS A survey covering VV-ECMO practice and opinions was distributed to attending members of the American Pediatric Surgical Association. RESULTS 137 pediatric surgeons responded (14%). Prior to discontinuation of the OriGen®, 82.5% offered VV-ECMO to neonates, and 79.6% cannulated with the OriGen®. Following its discontinuation, those that offered only venoarterial (VA)-ECMO to neonates increased to 37.6% from 17.5% (p = 0.0002). An additional 33.8% changed their practice to sometimes use VA-ECMO when VV-ECMO was indicated. Reasons for not incorporating dual-lumen bi-caval cannulation into practice included risk of cardiac injury (51.7%), inexperience with bi-caval cannulation in neonates (36.8%), difficulty with placement (31.0%), and recirculation and/or positioning problems (27.6%). For the pediatric/adolescent population, 95.5% of surgeons offered VV-ECMO prior to OriGen® discontinuation. Few switched to exclusive VA-ECMO (1.9%) when the OriGen® was discontinued, but 17.8% of surgeons began to incorporate selective use of VA-ECMO. CONCLUSION Discontinuation of the OriGen® cannula drove pediatric surgeons to alter their cannulation practices, dramatically increasing VA-ECMO use for neonatal and pediatric respiratory failure. These data may suggest a need for targeted education accompanying major technological shifts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mir Shanaz Hossain
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Faraz A Khan
- Department of Pediatric Surgery, Loma Linda Children's Hospital, Loma Linda, CA, USA
| | - Darrell L Cass
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Jason O Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
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Chock VY, Rao A, Van Meurs KP. Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy. Front Pediatr 2023; 11:1138062. [PMID: 36969281 PMCID: PMC10030520 DOI: 10.3389/fped.2023.1138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.
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Balegar V KK, Jayawardhana M, de Chazal P, Nanan RKH. Cerebral and splanchnic near-infrared spectroscopic dataset in premature newborns receiving packed red blood cell transfusion. Data Brief 2022; 46:108824. [PMID: 36593770 PMCID: PMC9803924 DOI: 10.1016/j.dib.2022.108824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
This article presents the near-infrared spectroscopy (NIRS) dataset of cerebral (StO2c) and splanchnic (StO2s) oxygenation in 29 stable premature infants admitted to a tertiary neonatal intensive care unit who received elective packed red blood cell transfusion (PRBCT) to treat anemia of prematurity. StO2c and StO2s data were prospectively recorded continuously from at least 4 hours before the beginning of PRBCT until 24 hours after its completion, using a 4-wavelength near-infrared spectroscopy (NIRS) monitor (FORE-SIGHT® absolute cerebral oximeter, CASMED, Branford, Connecticut, 06405 USA). StO2 data were downloaded as an analog output at a sampling rate of 1000Hz and aligned along the time axis in LabChart reader format (.adicht files) using a PowerLab data acquisition system [1] (PowerLab®, ADInstruments, Sydney, Australia). The .adicht files were then converted into .mat file format using a Python script (PythonTM version 3.7.3 [2]) and resampled at 1Hz for faster processing. Data that could not be physiologically explained (e.g., the absence of variability, [3] a 30% step change in StO2 between two subsequent data points for StO2[4]), as well as the data during the period of 'cares' were presumed to be artefactual and were replaced with 'NaN' or 'Not a Number' which is recognised by Matlab [5] (MATLAB 9.3, The MathWorks, Inc., Massachusetts, United States) and ignored for all subsequent processing while maintaining the correct time point of the StO2 signals. The data were then exported into Microsoft Excel format. The splanchnic cerebral oxygenation ratio (SCOR) was calculated as the ratio of StO2s/StO2c. A 4-hour mean pre-transfusion values (StO2s 0, StO2c 0, SCOR 0) and post-transfusion hourly mean values (1-28) were determined. Secondary data were derived from a Mixed Models for Repeated Measures (MMRM) analysis with the time point fitted as a fixed effect and the infant fitted as a random effect. The MMRM was used to perform paired comparisons between pre-transfusion and each of the post-baseline values. This article only provides the NIRS data. The secondary data and demography can be found in the article "Splanchnic-Cerebral Oxygenation Ratio associated with Packed Red Blood Cell Transfusion in preterm infants", published in Transfusion Medicine. [6] The data will be of use to researchers in neonatology, transfusion medicine, and physiology to understand changes in cerebral and splanchnic oxygenation associated with PRBCT. Data collection, processing, and analysis can be remodelled in larger multicentric randomised controlled studies to evaluate the effect of transfusion and feeding on transfusion-associated necrotising enterocolitis. The data are also helpful to explore the autoregulatory behaviour of the brain and gut when the oxygen content of blood is increased by administering PRBCT.
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Affiliation(s)
- Kiran Kumar Balegar V
- Department of Neonatology, Nepean Hospital, Sydney Medical School Nepean, The University of Sydney, NSW, Australia,Corresponding author. @kiranku98020067
| | - Madhuka Jayawardhana
- School of Electrical Engineering and the Charles Perkins Center, The University of Sydney, Australia
| | - Philip de Chazal
- School of Biomedical Engineering and the Charles Perkins Center, The University of Sydney, Australia
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Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants. J Perinatol 2022:10.1038/s41372-022-01576-2. [PMID: 36496514 DOI: 10.1038/s41372-022-01576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Near-infrared spectroscopy (NIRS) allows assessment of regional tissue oxygen delivery and extraction. There are doubts regarding reliability of gut NIRS measurements. This study assesses reliability of NIRS for monitoring gut oxygenation. STUDY DESIGN Splanchnic tissue haemoglobin index (sTHI), tissue oxygenation index (sTOI) and fractional tissue oxygen extraction (sFTOE) changes during blood transfusion were measured using NIRS and compared to stable control infants. Infants were grouped into 3 chronological age groups: 1-7, 8-28 and ≥29 days of life. RESULTS sTHI, sTOI significantly increased, and sFTOE reduced following blood transfusion in all age group infants (n = 59), with no changes seen in control infants (n = 12). Baseline characteristics including gestational age and feed volumes did not differ between groups. CONCLUSION Gut perfusion measured by NIRS improved in infants who received blood transfusion, a change not seen in the control group, thus suggesting NIRS is a reliable method to measure splanchnic tissue oxygenation.
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Renal oxygenation measured by near-infrared spectroscopy in preterm neonates in the first week. Pediatr Res 2022; 92:1744-1748. [PMID: 35354931 PMCID: PMC9522888 DOI: 10.1038/s41390-022-02036-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe renal regional saturation of oxygen (RrSO2) values during the first week of life for preterm neonates born at <32 weeks gestational age (GA). METHODS RrSO2 values recorded over the first week of life using near-infrared spectroscopy were retrospectively analyzed in this two-center cohort study of preterm infants without known congenital anomalies of the kidney. RESULTS A cohort of 109 neonates with a median GA of 26.9 weeks and a median of 120 (IQR: 87-141) hours of continuous RrSO2 monitoring were included. Separately fitted trends in RrSO2 did not differ (p = 0.52) between sites and demonstrated a consistent decrease in RrSO2 by 20 points (95% CI: 9.6-30.1) during the first 60 h of life, followed by a stabilization of RrSO2 thereafter. RrSO2 baseline trends increased by 2.1 (95% CI: 0.8-3.3) percentage points for each additional week GA between 24 and 32 weeks GA. CONCLUSIONS Despite differences in adjusted RrSO2 values between sites, profiles over time are consistent, allowing for the determination of RrSO2 trajectories in preterm infants. This expected pattern of RrSO2 changes in the first week may help guide future investigations and interventions to identify and reduce kidney injury in the preterm neonate. IMPACT Renal regional saturation of oxygen (RrSO2) slowly decreases during the first 60 h of age in <32-week preterm neonates. While site differences were identified with respect to absolute values, RrSO2 trends from two different centers were not different. Lower gestational age neonates have lower RrSO2 levels during the first week.
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Changes in regional oxygen saturation of the kidney and brain of infants during hospitalization. J Clin Monit Comput 2022; 36:1859-1867. [PMID: 35441944 DOI: 10.1007/s10877-022-00836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In pre-term infants, the postnatal changes in the regional oxygen saturation (rSO2) of the brain and kidney are unclear. METHODS We performed a prospective observational study. We measured the cerebral/renal rSO2 ratio and recorded the associated clinical features of infants born at 23 to 41 weeks of gestation weekly from the early postnatal period to discharge. RESULTS The median cerebral/renal rSO2 ratios (interquartile ranges) between birth and the expected date of birth were 1.13 (1.06-1.26) at 23-24 weeks (n = 7), 1.18 (1.10-1.32) at 25-26 weeks (n = 11), 1.24 (1.11-1.37) at 27-28 weeks (n = 9), 1.12 (1.05-1.19) at 29-30 weeks (n = 4), 1.11 (1.03-1.15) at 31-32 weeks (n = 5), 1.02 (0.98-1.06) at 33-34 weeks (n = 9), 0.98 (0.94-1.06) at 35-36 weeks (n = 19), and 0.95 (0.86-0.99) at 37-41 weeks of gestation (n = 22). The median cerebral/renal rSO2 ratio did not significantly change after birth, but with increasing gestational age, the cerebral/renal rSO2 ratio at the expected date of birth decreased (r = - 0.74, p < 0.001). Nephrotoxic drugs did not affect cerebral/renal rSO2 at the expected date of birth, after adjustment for clinical factors. CONCLUSIONS Unlike in most infants born after the late pre-term period, the renal rSO2 remained lower than the cerebral rSO2 on the expected date of birth in infants born very pre-term.
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Bailey SM, Prakash SS, Verma S, Desai P, Kazmi S, Mally PV. Near-infrared spectroscopy in the medical management of infants. Curr Probl Pediatr Adolesc Health Care 2022; 52:101291. [PMID: 36404215 DOI: 10.1016/j.cppeds.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016.
| | - Shrawani Soorneela Prakash
- Division of Neonatology, Department of Pediatrics, NYCHHC/Lincoln Medical and Mental Health Center, Bronx, NY 10451
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Purnahamsi Desai
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Sadaf Kazmi
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
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Hoffman SB, Magder LS, Viscardi RM. Renal versus cerebral saturation trajectories: the perinatal transition in preterm neonates. Pediatr Res 2022; 92:1437-1442. [PMID: 35177816 DOI: 10.1038/s41390-022-01984-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/04/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to develop reference renal saturation (rSrO2) curves in premature infants, depict how they differ from cerebral saturation (rScO2) curves, and evaluate the effect of blood pressure on these values using near-infrared spectroscopy (NIRS). METHODS This is a prospective cohort study of 57 inborn infants <12 h and <30 weeks gestation. rScO2, rSrO2, fractional tissue oxygen extraction (FTOE), and mean arterial blood pressure (MAP) were continuously monitored every 30 s for 96 h. Quantile regression was used to establish nomograms, and mean saturation values were evaluated for different MAP ranges. RESULTS Median rSrO2 at the start of monitoring was ~10% higher than rScO2. rSrO2 showed a significant decline over time while rScO2 peaked at 26 h. FTOE demonstrated a similar but inverse trend to their saturation counterparts. rScO2 declined as MAP increased, while rSrO2 showed a peak and decline as MAP increased. CONCLUSIONS We provide rSrO2 reference curves for the first 4 days of life, which differ in their trajectory from rScO2 and from what has previously been reported for rSrO2 in the full-term population. In addition, we observed a peak and decline in renal saturation with increasing MAP, suggesting a renovascular response to blood pressure changes. IMPACT This article depicts reference renal saturation curves during the perinatal transition in preterm infants. We show how renal saturation compares to cerebral saturation trends over time. We describe a peak and decline in renal saturation with increasing MAP, suggesting a renovascular response to blood pressure changes.
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Affiliation(s)
- Suma B Hoffman
- Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, MD, USA. .,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Children's National Health System - Neonatology, Washington, DC, USA.
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland Baltimore School of Medicine, Baltimore, MD, USA
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, MD, USA
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Kiran Kumar Balegar V, Jayawardhana M, de Chazal P, Nanan RKH. Splanchnic-cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants. Transfus Med 2022; 32:475-483. [PMID: 36222235 DOI: 10.1111/tme.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO2 s) to simultaneously measured cerebral tissue oxygen (StO2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT). AIM The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants. DESIGN Prospective cohort study. SETTING Neonatal intensive care. PATIENTS Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume. INTERVENTIONS PRBCT at 15 ml/kg, over 4 h. MAIN OUTCOME MEASURES Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pre-transfusion values (SCOR 0, StO2 s 0, and StO2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO2 s 1-28, and StO2 c 1-28). Dunnett's method was used to adjust for the multiplicity of the p value. RESULTS Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO2 c trend, while StO2 s remained unchanged throughout the study period. CONCLUSIONS AND RELEVANCE PRBCT-associated SCOR decrease suggests improvement in cerebral oxygenation rather than worsening splanchnic oxygenation. Our study underlines that it is necessary to determine individual components of SCOR, namely cerebral and splanchnic StO2 to understand SCOR changes in the context of PRBCT.
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Affiliation(s)
- V Kiran Kumar Balegar
- Department of Neonatology, Nepean Hospital, Sydney Medical School Nepean, The University of Sydney, Sydney, Australia
| | - Madhuka Jayawardhana
- School of Electrical Engineering, Charles Perkins Center, The University of Sydney, Sydney, Australia
| | - Philip de Chazal
- School of Biomedical Engineering, Charles Perkins Center, The University of Sydney, Sydney, Australia
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Chock VY, Smith E, Tan S, Ball MB, Das A, Hintz SR, Kirpalani H, Bell EF, Chalak LF, Carlo WA, Cotten CM, Widness JA, Kennedy KA, Ohls RK, Seabrook RB, Patel RM, Laptook AR, Mancini T, Sokol GM, Walsh MC, Yoder BA, Poindexter BB, Chawla S, D’Angio CT, Higgins RD, Van Meurs KP. Early brain and abdominal oxygenation in extremely low birth weight infants. Pediatr Res 2022; 92:1034-1041. [PMID: 35513716 PMCID: PMC9588487 DOI: 10.1038/s41390-022-02082-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/24/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined. METHODS A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables. RESULTS In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001). CONCLUSION Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population. IMPACT Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies. Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases. A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome. Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.
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Affiliation(s)
- Valerie Y. Chock
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA,Corresponding author: Valerie Y. Chock, MD, MS Epi, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA. 94304 USA, (650) 723-5711,
| | - Emily Smith
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Sylvia Tan
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - M. Bethany Ball
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Haresh Kirpalani
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Lina F. Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Kathleen A. Kennedy
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Robin K. Ohls
- University of New Mexico Health Sciences Center, Albuquerque, NM,Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ruth B. Seabrook
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Ravi M. Patel
- Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Toni Mancini
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Bradley A. Yoder
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Brenda B. Poindexter
- Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Sanjay Chawla
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Carl T. D’Angio
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD,College of Health and Human Services, George Mason University, Fairfax, VA
| | - Krisa P. Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
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Dani C, Ciarcià M, Miselli F, Luzzati M, Petrolini C, Corsini I, Simone P. Measurement of lung oxygenation by near-infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof-of-concept study. Pediatr Pulmonol 2022; 57:2306-2312. [PMID: 35018746 DOI: 10.1002/ppul.25824] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/20/2021] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Noninvasive markers more accurate than FiO2 would be useful to assess the severity of RDS and guide its treatment. Our aim was to assess for the first time the possibility of continuously monitoring lung oxygenation (rSO2 L) by near-infrared spectroscopy (NIRS) and to evaluate whether rSO2 L correlates with other oxygenation indices and RDS severity. METHODS We carried out this proof-of-concept study on 20 preterm infants with RDS requiring noninvasive respiratory support. Patients were continuously studied for 24 h by NIRS and rSO2 L was correlated with SpO2 /FiO2 ratio, a/APO2 , and O.I. RESULTS The overall value of rSO2 L was 80.1 ± 6.2%, without significant differences between the right and left hemithorax (80.2 ± 6.7 vs. 80.0 ± 5.7%; p = 0.869). Mean values of total, right, and left rSO2 L did not significantly change during the 24-h study period. Linear regression analysis demonstrated a significant positive relationship between total rSO2 L and SpO2 /FiO2 ratio (p < 0.001) and a/APO2 (p = 0.040), and a negative relationship between total rSO2 L and O.I. (r = -0.309; p = 0.022). CONCLUSIONS Continuous monitoring of rSO2 L by NIRS in preterm infants with RDS is feasible and safe. The correlation of rSO2 L with other indices of oxygenation and RDS severity supports the accuracy and reliability of this measurement.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Francesca Miselli
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Michele Luzzati
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Chiara Petrolini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Pratesi Simone
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
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Wu S, Di S, Liu T, Shi Y. Emerging prediction methods for early diagnosis of necrotizing enterocolitis. Front Med (Lausanne) 2022; 9:985219. [PMID: 36186788 PMCID: PMC9523100 DOI: 10.3389/fmed.2022.985219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is a life-threatening disease of the digestive system that occurs in the neonatal period. NEC is difficult to diagnose early and the prognosis is poor. Previous studies have reported that abnormalities can be detected before the presentation of clinical symptoms. Based on an analysis of literature related to the early prediction of NEC, we provide a detailed review on the early prediction and diagnosis methods of NEC, including ultrasound, near-infrared spectroscopy, biomarkers, and intestinal microbiota. This review aimed to provide a reference for further research and clinical practice.
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Balegar V. KK, Jayawardhana M, Martin AJ, de Chazal P, Nanan RKH. Hierarchical improvement of regional tissue oxygenation after packed red blood cell transfusion. PLoS One 2022; 17:e0271563. [PMID: 35857790 PMCID: PMC9299358 DOI: 10.1371/journal.pone.0271563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background It is well established that counter-regulation to hypoxia follows a hierarchical pattern, with brain-sparing in preference to peripheral tissues. In contrast, it is unknown if the same hierarchical sequence applies to recovery from hypoxia after correction of anemia with packed red blood cell transfusion (PRBCT). Objective To understand the chronology of cerebral and splanchnic tissue oxygenation resulting after correction of anemia by PRBCT in preterm infants using near-infrared spectroscopy (NIRS). Design Prospective cohort study. Setting Neonatal intensive care. Patients included Haemodynamically stable infants: <32 weeks gestation, <37weeks postmenstrual age, <1500 grams birth weight; and ≥120 mL/kg/day feeds tolerated. Intervention PRBCT at 15 mL/Kg over 4 hours. Main outcome measures Transfusion-associated changes were determined by comparing the 4-hour mean pre-transfusion cerebral and splanchnic fractional tissue oxygen extraction (FTOEc0; FTOEs0) with hourly means during (FTOEc1-4; FTOEs1-4) and for 24 hours after PRBCT completion (FTOEc5-28; FTOEs5-28). Results Of 30 enrolled infants, 14[46.7%] male; median[IQR] birth weight, 923[655–1064]g; gestation, 26.4[25.5–28.1]weeks; enrolment weight, 1549[1113–1882]g; and postmenstrual age, 33.6[32.4–35]weeks, 1 infant was excluded because of corrupted NIRS data. FTOEc significantly decreased during and for 24 hours after PRBCT (p < 0.001), indicating prompt improvement in cerebral oxygenation. In contrast, FTOEs showed no significant changes during and after PRBCT (p>0.05), indicating failure of improvement in splanchnic oxygenation. Conclusion Improvement in regional oxygenation after PRBCT follows the same hierarchical pattern with a prompt improvement of cerebral but not splanchnic tissue oxygenation. We hypothesise that this hierarchical recovery may indicate continued splanchnic hypoxia in the immediate post-transfusion period and vulnerability to transfusion-associated necrotizing enterocolitis (TANEC). Our study provides a possible mechanistic underpinning for TANEC and warrants future randomised controlled studies to stratify its prevention.
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Affiliation(s)
- Kiran Kumar Balegar V.
- Department of Neonatology, Nepean Hospital, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Madhuka Jayawardhana
- School of Electrical Engineering and the Charles Perkins Center, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J. Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Philip de Chazal
- School of Biomedical Engineering and the Charles Perkins Center, The University of Sydney, Sydney, NSW, Australia
| | - Ralph Kay Heinrich Nanan
- Sydney Medical School and Charles Perkins Center Nepean, The University of Sydney, Sydney, NSW, Australia
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Surak A, Lalitha R, Bitar E, Hyderi A, Hicks M, Cheung PY, Kumaran K. Multimodal Assessment of Systemic Blood Flow in Infants. Neoreviews 2022; 23:e486-e496. [PMID: 35773505 DOI: 10.1542/neo.23-7-e486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The assessment of systemic blood flow is a complex and comprehensive process with clinical, laboratory, and technological components. Despite recent advancements in technology, there is no perfect bedside tool to quantify systemic blood flow in infants that can be used for clinical decision making. Each option has its own merits and limitations, and evidence on the reliability of these physiology-based assessment processes is evolving. This article provides an extensive review of the interpretation and limitations of methods to assess systemic blood flow in infants, highlighting the importance of a comprehensive and multimodal approach in this population.
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Affiliation(s)
- Aimann Surak
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Renjini Lalitha
- Division of Neonatology, London Health Sciences Centre, London, ON, Canada
| | - Eyad Bitar
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Abbas Hyderi
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Matt Hicks
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Po Yin Cheung
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada.,Department of Pharmacology and Surgery, University of Alberta, Edmonton, AB, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Edmonton, AB, Canada
| | - Kumar Kumaran
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
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Balegar V KK, Low GKK, Nanan RKH. Regional tissue oxygenation and conventional indicators of red blood cell transfusion in anaemic preterm infants. EClinicalMedicine 2022; 46:101365. [PMID: 35399813 PMCID: PMC8987388 DOI: 10.1016/j.eclinm.2022.101365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/26/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is unresolved whether low haemoglobin (Hb) and symptoms of anaemia reflect oxygen delivery-consumption imbalances (fractional tissue oxygen extraction [FTOE]). Here, we test whether pre-transfusion Hb and symptoms of anaemia correlate with pre-transfusion cerebral and splanchnic FTOE. METHODS This prospective cohort study was carried out between Sept 1, 2014 and Nov 30, 2016 at Nepean Hospital, Sydney, Australia. The study enroled haemodynamically stable preterm infants: gestation <32 weeks; birth weight <1500 gs; postmenstrual age <37weeks, who received 15 mL/kg packed red blood cell transfusion (PRBCT) based on low Hb and symptoms of anaemia. FTOE was determined using simultaneous monitoring of near-infrared spectroscopy and pulse oximetry for 4 h before PRBCT. FINDINGS The study enroled 29 infants born with a median gestation of 26.4 weeks (IQR 25.4-28.1), birth weight 922 g (655-1064), at postmenstrual age 33.6 weeks (31.7-34.9), and weight 1487 g (1110-1785). There was no significant correlation between Hb (median 97 g/L, IQR 87-100) and cerebral FTOE (r=-0.12, 95% CI -0.47 to 0.27; p = 0.54, n = 29) as well as splanchnic FTOE (r=-0.09, 95% CI -0.45 to 0.29; p = 0.64, n = 29). Median cerebral FTOE (p = 0.67) and splanchnic FTOE (p = 0.53) did not differ between symptomatic and asymptomatic groups. INTERPRETATION Our preliminary findings suggest that pre-transfusion Hb and symptoms of anaemia might not accurately reflect oxygen delivery-consumption imbalances in both the brain and the gut. A lack of correlation with cerebral FTOE might be presumed to be due to the brain-sparing effect. However, the lack of correlation with splanchnic FTOE is more concerning. Hence, these results warrant larger studies incorporating FTOE along with the conventional criteria in the transfusion algorithm. FUNDING The study was funded (for the purchase of NIRS sensors) by the Australian Women and Children's Research Foundation.
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Key Words
- Anaemia
- CPAP, Continuous positive airway pressure
- DO2`, Oxygen delivery
- FTOE, Fractional tissue oxygen extraction
- Fractional tissue oxygen extraction
- HFNC, High Flow Nasal Cannula
- Haemoglobin
- Hb, Haemoglobin
- NEC, Necrotising Enterocolitis
- NIRS, Near Infrared Spectroscopy
- PDA, Patent Ductus Arteriosus
- PRBCT, Packed Red Blood Cell Transfusion
- Packed red blood cell transfusions
- Preterm
- StO2, Tissue oxygen saturation
- VO2, Oxygen consumption
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Affiliation(s)
- Kiran Kumar Balegar V
- Department of Neonatology, Nepean Hospital, Nepean Blue Mountains Local Health District, Derby St, Kingswood, NSW 2750, Australia
- Sydney Medical School Nepean, NSW, Australia
- The University of Sydney, NSW, Australia
- Corresponding author at: Department of Neonatology, Nepean Hospital, Nepean Blue Mountains Local Health District, Derby St 2747, Kingswood, NSW 2750, Australia.
| | - Gary KK Low
- Research Operations, Nepean Hospital, Nepean Blue Mountains Local Health District, Derby St, Kingswood, NSW, 2750, Australia
| | - Ralph KH Nanan
- The University of Sydney, NSW, Australia
- Charles Perkins Center Nepean, NSW, Australia
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Variane GFT, Camargo JPV, Rodrigues DP, Magalhães M, Mimica MJ. Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care. Front Pediatr 2022; 9:755144. [PMID: 35402367 PMCID: PMC8984110 DOI: 10.3389/fped.2021.755144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Division of Neonatology, Grupo Santa Joana, São Paulo, Brazil
| | - João Paulo Vasques Camargo
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Data Science Department, OPD Team, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maurício Magalhães
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Jenné Mimica
- Department of Pathology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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35
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Howarth CN, Leung TS, Banerjee J, Eaton S, Morris JK, Aladangady N. Regional cerebral and splanchnic tissue oxygen saturation in preterm infants - Longitudinal normative measurements. Early Hum Dev 2022; 165:105540. [PMID: 35065416 DOI: 10.1016/j.earlhumdev.2022.105540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate regional splanchnic and cerebral tissue oxygen saturation in preterm infants <30 weeks gestation. METHODS Cerebral (cTOI) and splanchnic (sTOI) Tissue Oxygenation Index were measured weekly in 5 min epochs for a total period of 60 min using NIRS (NIRO-300) for the first 8 weeks of life, in 48 appropriately grown preterm infants born at <30 weeks gestation. Infants who developed HPI and/or NEC (n = 12) and those that died (n = 1) were excluded from our main outcome measure of regional gut and cerebral tissue oxygenation in healthy preterm infants <30 weeks gestation. RESULTS Median birthweight 789 g (460-1486), gestational age 25+6 weeks (23+0-29+1) and 51.4% female. 217 NIRS measurements were completed across the first 8 weeks of life. Mean weekly cTOI ranged from 56.8-65.4% and sTOI ranged from 36.7-46.0%. Mean cTOI was significantly higher than mean sTOI (p < 0.001) throughout the first 8 weeks of life. Mean cTOI decreased significantly with increasing postnatal age [-0.59% each week (-1.26% to -0.07%) p = 0.04]. None of the examined confounding factors had a significant effect. CONCLUSIONS This is the first report of regional cerebral and splanchnic tissue oxygen saturation ranges during the first 8 weeks of life for preterm infants born at <30 weeks gestation.
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Affiliation(s)
- Claire N Howarth
- Homerton University Hospital NHS Foundation Trust, London, UK; Queen Mary University of London, London, UK.
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Jayanta Banerjee
- Imperial College Healthcare NHS Trust, London, UK; Imperial College London, UK
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Narendra Aladangady
- Homerton University Hospital NHS Foundation Trust, London, UK; Queen Mary University of London, London, UK
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Mishra V, Mathur AA, Mohamed S, Maheshwari A. Role of Near-infrared Spectroscopy in the Diagnosis and Assessment of Necrotizing Enterocolitis. NEWBORN (CLARKSVILLE, MD.) 2022; 1:177-181. [PMID: 36864826 PMCID: PMC9976547 DOI: 10.5005/jp-journals-11002-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a noninvasive, bedside diagnostic tool that could assist in the early diagnosis of necrotizing enterocolitis (NEC) in preterm neonates. NIRS is a safe and effective clinical tool in the neonatal intensive care unit to detect abnormal alterations in tissue perfusion and oxygenation. In addition, NIRS could also detect the complications of NEC, such as bowel necrosis and perforation. NEC is the most common gastrointestinal complication associated with preterm birth and critically ill infants. It is observed in 6-10% of preterm neonates, weighing below 1500 g, leading to considerable morbidity, mortality, and healthcare cost burden. The mortality rate ranges from 20 to 30%, highest in NEC infants undergoing surgery. NIRS is a promising diagnostic modality that could facilitate the early diagnosis of NEC and early detection of complications alone or with the imaging modalities.
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Affiliation(s)
- Vinayak Mishra
- Department of Pediatrics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Amit A Mathur
- Department of Pediatrics, Saint Louis University, St Louis, Missouri, United States of America
| | - Shakir Mohamed
- Department of Neonatal-Perinatal Medicine, Saint Louis University School of Medicine, St Louis, Missouri, United States of America
| | - Akhil Maheshwari
- Global Newborn Society, Baltimore, Maryland, United States of America
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Howarth C, Banerjee J, Leung T, Aladangady N. Could Near Infrared Spectroscopy (NIRS) be the new weapon in our fight against Necrotising Enterocolitis? Front Pediatr 2022; 10:1024566. [PMID: 36425397 PMCID: PMC9679512 DOI: 10.3389/fped.2022.1024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
There is no ideal single gut tissue or inflammatory biomarker available to help to try and identify Necrotising Enterocolitis (NEC) before its clinical onset. Neonatologists are all too familiar with the devastating consequences of NEC, and despite many advances in neonatal care the mortality and morbidity associated with NEC remains significant. In this article we review Near Infrared Spectroscopy (NIRS) as a method of measuring regional gut tissue oxygenation. We discuss its current and potential future applications, including considering its effectiveness as a possible new weapon in the early identification of NEC.
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Affiliation(s)
- Claire Howarth
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - Jayanta Banerjee
- Neonatal Unit, Imperial College Healthcare NHS Trust and Imperial College London, London, United Kingdom
| | - Terence Leung
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Narendra Aladangady
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, United Kingdom
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Upadhyay J, Kumar S, Singh P, Basu S. Cortical hemodynamic activity and pain perception during insertion of feeding tubes in preterm neonates: a randomized controlled cross-over trial. J Perinatol 2022; 42:121-125. [PMID: 34285360 DOI: 10.1038/s41372-021-01166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/07/2021] [Accepted: 07/13/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present study evaluated the pain perception in preterm neonates during insertion of orogastric (OG) vs. nasogastric (NG) tube by measuring the cerebral regional oxygen saturation (crSO2) and premature infant pain profile-revised (PIPP-R) score. STUDY DESIGN Randomized controlled cross-over trial. RESULTS Fifty infants of mean (SD) gestational age of 31.54(2) and 31.64(2.2) weeks, birth weight of 1362(354) and 1507(365) grams were randomized into OG/NG (n = 25) and NG/OG (n = 25) sequences. Mean post-menstrual age at assessment was 33(2.8) and 33(1.5) weeks, and the difference between two interventions was 1.08(0.5) and 1.12(0.5) days in OG-NG and NG-OG, respectively. Mean crSO2(%) during insertion was significantly lower with NG compared to OG route. Mean PIPP-R score, heart rate variability, time to normalize crSO2, and the duration of cry were also significantly higher with NG insertion. CONCLUSIONS Compared to OG, NG route of feeding tube insertion was associated with higher fluctuations in crSO2 and higher PIPP-R scores. CLINICAL TRIAL REGISTRY OF INDIA (CTRI) REGISTRATION NO CTRI/2020/03/023728.
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Affiliation(s)
- Jaya Upadhyay
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Sourabh Kumar
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India.
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Zhang M, Yang Y, Chen X, Song Y, Zhu L, Gong X, Zhang H, Xu Z. Application of Near-Infrared Spectroscopy to Monitor Perfusion During Extracorporeal Membrane Oxygenation After Pediatric Heart Surgery. Front Med (Lausanne) 2021; 8:762731. [PMID: 34881265 PMCID: PMC8645544 DOI: 10.3389/fmed.2021.762731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Venoarterial extracorporeal membrane oxygenation is an effective mechanical circulatory support that is used to rescue critically ill patients after congenital heart surgery. As there was still no recommended guideline for monitoring parameters during extracorporeal membrane oxygenation (ECMO), this study aimed to investigate the role of near-infrared spectroscopy (NIRS) in the early period of venoarterial (VA)-ECMO. Method: This study enrolled patients with NIRS monitoring during ECMO after pediatric cardiac surgery at Shanghai Children's Medical Center (2018-2020). The information obtained from the retrospective, the observational dataset included the demographic information, diagnoses, baseline characteristics, procedural details, ECMO data, monitoring data, in-hospital mortality, and complications of the patients. Results: The overall mortality rate was 43.6%. Lactate was significantly higher in non-survivors compared to survivors at 12 h (11.25 ± 7.26 vs. 6.96 ± 5.95 mmol/l, p = 0.022) and 48 h [2.2 (0.7, 20) vs. 1.4 (0.7, 5.8) mmol/l, p = 0.008] after initiation of ECMO. The cranial regional oxygen saturation (CrSO2) was significantly higher in survivors compared to non-survivors at 24 h (62.5 ± 14.61 vs. 52.05 ± 13.98%, p = 0.028), 36 h (64.04 ± 14.12 vs. 51.27 ± 15.65%, p = 0.005), and 48 h (65.32 ± 11.51 vs. 55.00 ± 14.18%, p = 0.008). Multivariate logistics regression analysis of the hemodynamic and laboratory parameters revealed that the CrSO2 at 36 h (OR = 0.945, p = 0.049) and 48 h (OR = 0.919, p = 0.032) was related to mortality. The use of continuous renal replacement therapy (OR = 14.940, p = 0.039) was also related to mortality. The optimal cutoff values for CrSO2 for predicting mortality after weaning off ECMO at 36 and 48 h were 57% (sensitivity: 61.5%, specificity: 80%) and 56% (sensitivity: 76.9%, specificity: 70%), respectively. The risk of mortality was higher among patients with a CrSO2(36h) < 57% (p = 0.028) by Kaplan-Meier analysis. Conclusion: Near-infrared spectroscopy may be a useful tool for monitoring the hemodynamic stability during the early period of ECMO, while CrSO2 can predict the in-hospital mortality after ECMO.
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Affiliation(s)
- Mingjie Zhang
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yinyu Yang
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Chen
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yixiao Song
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Limin Zhu
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolei Gong
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haibo Zhang
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuoming Xu
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Navikiene J, Virsilas E, Vankeviciene R, Liubsys A, Jankauskiene A. Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants: a prospective observational study. BMC Pediatr 2021; 21:559. [PMID: 34886825 PMCID: PMC8656008 DOI: 10.1186/s12887-021-03036-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patent ductus arteriosus (PDA) is common among preterm neonates. Haemodynamically significant ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes. Our aim was to evaluate ductus arteriosus patency and significance using two-site near-infrared spectroscopy (NIRS) measurements in preterm infants older than 72 h as a supplemental tool to echocardiography. Methods In this prospective observational study, 123 preterm infants (gestational age (GA) < 32 weeks, birth weight < 1500 g) were enrolled. Sixty-four newborns had closed ductus arteriosus (noPDA), and 41 and 18 patients were assigned to the PDA and hsPDA groups, respectively, per predefined echocardiographic criteria. Cerebral and renal oxygenation were assessed during NIRS monitoring. Results A higher renal mean (±SD) regional tissue oxygen saturation (rSpO2) (76.7 (±7.64)) was detected in the noPDA group than in the PDA (71.7 (±9.02)) and hsPDA (67.4 (±13.48)) groups (p < 0.001). Renal fractional tissue oxygen extraction (FTOE) (0.18 (±0.079)) was lower in the noPDA group than in the PDA (0.23 (±0.092)) and hsPDA (0.24 (±0.117))0.117 groups (p = 0.002). Cerebral oxygenation was significantly lower in the hsPDA group (77.0 (±5.16)) than in the noPDA (79.3 (±2.45)) and PDA (79.7 (±2.27)) groups (p = 0.004). There was no significant difference in cerebral fractional tissue oxygen extraction (FTOE) between any of the groups. Conclusions Our results suggest that renal oxygenation is affected by ductus patency in preterm infants older than 72 h. Significant differences in cerebral oxygenation were observed between the hsPDA group and the PDA and noPDA groups. Trial registration ClinicalTrials.gov Identifier: NCT04295395. Registration date: 4 March 2020. This study was retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04295395.
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Affiliation(s)
- Jurate Navikiene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
| | - Ernestas Virsilas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Ramune Vankeviciene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Arunas Liubsys
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
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41
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Renal tissue oxygenation after caffeine administration in preterm neonates. Pediatr Res 2021; 90:1171-1176. [PMID: 34006983 DOI: 10.1038/s41390-021-01579-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Caffeine has been associated with reduced rates of acute kidney injury (AKI) in preterm neonates. The effect of caffeine on preterm neonatal renal regional saturation of oxygen (RrSO2) is unknown. METHODS RrSO2 was recorded continuously in neonates < 32 weeks' gestation until 7 days of age with INVOS™ neonatal near-infrared spectroscopy (NIRS) sensors. Baseline RrSO2 values were established by averaging the saturations in the 20 min prior to caffeine administration. Subgroup analysis was performed based on pre-caffeine RrSO2 averages. Change in RrSO2 was recorded at 0.5, 1, 2, 3, 4, 6, and 12 h after maintenance caffeine administration. RESULTS Of 35 eligible neonates, 31 (median gestational age 28.4 weeks) received 156 caffeine doses (median 8 mg/kg). Analysis of combined doses showed no significant changes in RrSO2 after caffeine administration at any time. However, neonates with baseline 20-29.9% had significant increases from 1 to 12 h (range of increase 5.9-13.9%), and those with baseline 30-39.9 had significant increases at 1 h (8.06%, p < 0.05). CONCLUSIONS Maintenance caffeine dosing increased RrSO2 in neonates with low RrSO2 in the first week. Further research is needed to determine the effect of loading doses of caffeine and if increases in RrSO2 correlate with improved clinical kidney outcomes. IMPACT Caffeine administration is associated with increased renal tissue oxygenation in preterm neonates with low baseline values under 40%. The most significant renal tissue oxygenation changes occur in the first 3 h after IV caffeine administration. With recent studies suggesting low RrSO2 values in preterm neonates are associated with AKI, caffeine should be studied as a potential therapeutic for this common and complex morbidity in preterm neonates.
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Zhang JH, Guan RL, Pan PP, Lu WN, Zhang HY. Changing trend of abdominal regional oxygen saturation in very/extremely low birth weight infants in the early postnatal stage: a prospective study. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1015-1020. [PMID: 34719416 DOI: 10.7499/j.issn.1008-8830.2105156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the changing trend of abdominal regional oxygen saturation (A-rSO2) in very/extremely low birth weight (VLBW/ELBW) infants after birth. METHODS The VLBW/ELBW infants who were admitted to the neonatal intensive care unit from September 2019 to May 2021 were enrolled as subjects. Near-infrared spectroscopy was used to monitor A-rSO2 since day 1 after birth for 4 weeks. According to gestational age, the infants were divided into a low gestational age (<29 weeks) group and a high gestational age (≥29 weeks) group. The two groups were compared in terms of A-rSO2 within 4 weeks after birth. RESULTS A total of 63 VLBW/ELBW infants were enrolled, with 30 infants in the <29 weeks group and 33 in the ≥29 weeks group. A-rSO2 fluctuated within the first 2 weeks after birth in the 63 infants and had the lowest level of 47.9% on day 1 after birth and then gradually increased, reaching the peak level of 67.4% on day 4; it gradually decreased on days 5-9, then gradually increased, and became relatively stable 2 weeks after birth. The ≥29 weeks group had significantly higher A-rSO2 than the <29 weeks group at weeks 1 and 2 after birth (P<0.05), while there was no significant difference in A-rSO2 between the two groups at weeks 3 and 4 after birth (P>0.05). CONCLUSIONS In infants with VLBW/ELBW, A-rSO2 fluctuates within the first 2 weeks after birth and then gradually becomes stable. A-rSO2 is associated with gestational age within 2 weeks after birth.
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Affiliation(s)
- Jing-Hua Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Rui-Lian Guan
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Pian-Pian Pan
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Wei-Neng Lu
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Hua-Yan Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
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Metcalfe KHM, Stienstra R, McHoney M. NIRS as a biomarker of bowel ischaemia & surgical pathology: A meta-analysis of studies in newborns. Early Hum Dev 2021; 161:105437. [PMID: 34411803 DOI: 10.1016/j.earlhumdev.2021.105437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We performed a meta-analysis on Near-infrared Spectroscopy (NIRS) as a biomarker of bowel ischaemia. SUMMARY BACKGROUND DATA NIRS allows non-invasive assessment of gastrointestinal regional oxygen saturation (GrSO2). Studies to date have focused on the feasibility of NIRS in clinical practice and its reproducibility. GrSO2 can be used alone, or in conjunction with cerebral NIRS to give a Cerebral Splanchnic Oxygenation Ratio (CSOR). We assess published data on abdominal NIRS as a marker of bowel ischaemia. METHODS A literature review was conducted using the PRISMA method. Data on GrSO2 and CSOR in controls and patients with confirmed ischaemia was included in a meta-analysis, and used to identify a diagnostic threshold. RESULTS 14 studies were identified. Meta-analysis demonstrated that GrSO2 (p < 0.01) and CSOR (p < 0.01) were significantly lower in neonates with bowel pathology associated with ischaemia than controls. Area under the curve for GrSO2 was 0.80, with Youden's index highest (0.52) at a GrSO2 of 42% (specificity 91% and sensitivity 62%). For CSOR, area under the curve is 0.89, with Youden's index highest (0.69) at 0.76 (specificity of 80%, sensitivity 90%). CONCLUSIONS Splanchnic NIRS correlates with bowel ischaemia. Low GrSO2 is consistently associated with ischaemia, although a specific cut off level in each patient is hard to define. However, values below 42% correlate strongly with ischaemia while values above 52% are more suggestive of patients without bowel pathology. CSOR of below 0.76 is strongly suggestive of ischaemia. Trends within individuals are likely to be able to provide even more clinically correlatable and diagnostic data.
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Affiliation(s)
- Kiloran H M Metcalfe
- University of Edinburgh, College of Medicine, United Kingdom of Great Britain and Northern Ireland
| | - Roxane Stienstra
- Department Paediatric Surgery, Royal Hospital for sick Children Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Merrill McHoney
- University of Edinburgh, College of Medicine, United Kingdom of Great Britain and Northern Ireland; Department Paediatric Surgery, Royal Hospital for sick Children Edinburgh, United Kingdom of Great Britain and Northern Ireland.
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Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values. Pediatr Res 2021; 90:882-887. [PMID: 33504960 DOI: 10.1038/s41390-020-01323-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Near-infrared spectroscopy is used in the assessment of regional splanchnic oxygen saturation (rsSO2), but solid reference values are scarce. We aimed to establish reference values of rsSO2 for preterm infants during the first week after birth, both crude and modeled based on predictors. METHODS We included infants with gestational age (GA) <32 weeks and/or birth weight <1200 g. We excluded infants who developed necrotizing enterocolitis or sepsis or who died. In the first week after birth, we determined a daily 2-h mean of rsSO2 to assess its associations with sex, GA, postnatal age (PNA), small-for-gestational age (SGA) status, patent ductus arteriosus, hemoglobin, nutrition, and head circumference at birth and translated those into a prediction model. RESULTS We included 220 infants. On day 1, the mean ± SD rsSO2 value was 48.2% ± 16.6. The nadir of rsSO2 was on day 4 (38.7% ± 16.6 smoothed line) to 5 (37.4%±17.3, actual data), after which rsSO2 increased to 44.2% ± 16.6 on day 7. The final model of the reference values of rsSO2 included the following coefficients: rsSO2 = 3.2 - 7.0 × PNA + 0.8 × PNA2 - 4.0 × SGA + 1.8 × GA. CONCLUSIONS We established reference values of rsSO2 for preterm infants during the first week after birth. GA, PNA, and SGA affect these values and need to be taken into account. IMPACT Regional splanchnic oxygen saturation is lower in infants with a lower gestational age and in small-for-gestational age infants. Regional splanchnic oxygen saturation decreases with a higher postnatal age until day 4 after birth and then increases until day 7 after birth. Gestational age, postnatal age, and small-for-gestational age status affect regional splanchnic oxygen saturation and need to be taken into account when interpreting regional splanchnic oxygen saturations using NIRS. Reference values for infant regional splanchnic oxygen saturation can be computed with a formula based on these variables, as provided by this study.
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Renal Oxygenation (rSO2) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy. Adv Neonatal Care 2021; 22:370-377. [PMID: 34417355 DOI: 10.1097/anc.0000000000000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, reference ranges for renal oxygenation measured by near-infrared spectroscopy (NIRS) in preterm infants beyond the first days of life are lacking, especially those born prior to 29 weeks' gestation. Population estimates of renal oxygenation (rSO2) levels among preterm infants over time have yet to be established, leading to reluctance in clinical application. PURPOSE To characterize the distribution and estimate population parameters for renal oxygenation measured by NIRS during the first 14 days of life among preterm infants. METHODS We prospectively observed rSO2 trends of 37 infants before 34 weeks' gestation and 1800-g or less birth weight for the first 14 days of life. Analyses included distribution fit tests, ordinary least squares (OLS) regression, and t tests. RESULTS Average daily rSO2 variation steadily increased with 42% difference through the first 14 days of life. For all infants, renal rSO2 means peaked during the first 3 days of life and plateaued around 7 days. Daily rSO2 slopes were significantly lower among males and infants 29 weeks' or less gestation. IMPLICATIONS FOR PRACTICE Renal rSO2 during the first 14 days of life reflects normal extrauterine transition reaching stabilization around 7 days of life. Gestational age, birth weight, and gender may predict the early trajectory of rSO2 patterns. Population estimates provide parameters for renal rSO2 that may indicate early-onset tissue hypoxia when acute or significant drops from baseline occur. IMPLICATIONS FOR RESEARCH We present a framework to guide future research using renal NIRS technology in preterm infants to determine deviations from expected trends that may precede renal injury.
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Abstract
OBJECTIVE The aim of this study is to assess the effects of administering 20 mg/kg loading dose of caffeine citrate intravenously on splanchnic oxygenation in preterm infants. STUDY DESIGN The infants with a gestational age (GA) of <34 weeks who were administered with a 20 mg/kg intravenous loading dose of caffeine citrate within 48 hours after birth were investigated prospectively. Regional splanchnic oxygen saturation (rsSO2) and splanchnic fractional tissue oxygen extraction rate (sFTOE) were measured using near-infrared spectroscopy before caffeine infusion, immediately after caffeine infusion and 1, 2, 3, 4, and 6 hours (h) after dose completion; postdose values were compared with predose values. RESULTS A total of 41 infants with a mean GA of 29.2 ± 1.6 weeks and birth weight of 1,315 ± 257 g as well as postnatal age of 32.2 ± 10.8 hours were included in the study. rsSO2 significantly reduced from 63.1 to 57.5% immediately after caffeine infusion, 55.1% after 1 hour, and 55.2% after 2 hours with partial recovery at 3-hour postdose. sFTOE increased correspondingly. CONCLUSION Caffeine reduces splanchnic oxygenation and increases splanchnic oxygen extraction for at least 2 hours with partial recovery to predose levels at 3-hour postdose.
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Affiliation(s)
- Ozkan Ilhan
- Department of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Meltem Bor
- Department of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
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Jani PR, Lowe K, Perdomo A, Wakefield L, Hinder M, Galea C, Goyen TA, Halliday R, Waters KA, Badawi N, Tracy M. Cerebral Oxygenation and Perfusion when Positioning Preterm Infants: Clinical Implications. J Pediatr 2021; 235:75-82.e1. [PMID: 33857466 DOI: 10.1016/j.jpeds.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate cerebral tissue oxygenation (cTOI) and cerebral perfusion in preterm infants in supine vs prone positions. STUDY DESIGN Sixty preterm infants, born before 32 weeks of gestation, were enrolled; 30 had bronchopulmonary dysplasia (BPD, defined as the need for respiratory support and/or supplemental oxygen at 36 weeks of postmenstrual age). Cerebral perfusion, cTOI, and polysomnography were measured in both the supine and prone position with the initial position being randomized. Infants with a major intraventricular hemorrhage or major congenital abnormality were excluded. RESULTS Cerebral perfusion was unaffected by position or BPD status. In the BPD group, the mean cTOI was higher in the prone position compared with the supine position by a difference of 3.27% (P = .03; 95% CI 6.28-0.25) with no difference seen in the no-BPD group. For the BPD group, the burden of cerebral hypoxemia (cumulative time spent with cTOI <55%) was significantly lower in the prone position (23%) compared with the supine position (29%) (P < .001). In those without BPD, position had no effect on cTOI. CONCLUSIONS In preterm infants with BPD, the prone position improved cerebral oxygenation and reduced cerebral hypoxemia. These findings may have implications for positioning practices. Further research will establish the impact of position on short- and long-term developmental outcomes.
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Affiliation(s)
- Pranav R Jani
- Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
| | - Krista Lowe
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Aldo Perdomo
- Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Murray Hinder
- Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Claire Galea
- University of Sydney, Sydney, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The Cerebral Palsy Alliance, Allambie Heights, New South Wales, Australia
| | | | - Robert Halliday
- University of Sydney, Sydney, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Karen Ann Waters
- University of Sydney, Sydney, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nadia Badawi
- University of Sydney, Sydney, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The Cerebral Palsy Alliance, Allambie Heights, New South Wales, Australia
| | - Mark Tracy
- Westmead Hospital, Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Acute kidney injury (AKI) affects approximately 30% of infants admitted to the neonatal intensive care unit (NICU), and increases mortality risk by 50%. Current diagnostic criteria (serum creatinine rise with oliguria) cannot detect early-onset AKI, as up to 50% of nephron damage may occur by the time these abnormalities present. Once AKI is established, clinical management is often ineffective; therefore, prevention is key. Near-infrared spectroscopy (NIRS) offers a feasible, noninvasive approach to continuously monitor renal oxygenation trends over time, serving as a surrogate marker for renal perfusion. PURPOSE To provide an overview of NIRS principles for measuring renal oxygenation, and to describe current evidence of how this technology is being used among infants admitted to the NICU relative to the prediction and identification of AKI. METHODS A comprehensive search of PubMed and CINHAL focused on renal NIRS studies in NICU preterm and term infants was conducted. RESULTS Findings from 34 studies were included. In term infants, reduced renal oxygenation correlated to invasive SvO2 monitoring, predicted survivability and AKI. In preterm infants, reduced renal oxygenation was associated with AKI in one study, yet contrasting findings were reported in those with patent ductus arteriosus, including those who received prostaglandin inhibitors. Normative data in all infants were sparse. IMPLICATIONS FOR PRACTICE Renal NIRS may offer a noninvasive measurement of kidney hypoperfusion that may precede conventional diagnostic measures. IMPLICATIONS FOR RESEARCH Normative data are lacking, the threshold for renal ischemia is not defined, and consensus guiding clinical treatment based on NIRS data is nonexistent.
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Le Bouhellec J, Prodhomme O, Mura T, Jacquot A, Combes C, Gamon L, Durand S, Filleron A, Cambonie G. Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms? Am J Perinatol 2021; 38:e299-e308. [PMID: 32325507 DOI: 10.1055/s-0040-1710033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In premature neonates, bloody stools and/or abdominal distension with feeding intolerance may be inaugural signs of necrotizing enterocolitis (NEC). We assessed the ability of near-infrared spectroscopy (NIRS) to distinguish those neonates with NEC soon after the occurrence of these symptoms. STUDY DESIGN We prospectively collected NIRS measurements of abdominal and cerebral regional tissue oxygen saturation (r-SO2), with values masked by an opaque cover. Two physicians, blinded to the NIRS data, determined whether the gastrointestinal symptoms were related to NEC 10 days after symptom onset. RESULTS Forty-five neonates with mean (standard deviation [SD]) gestational, birth weight and postnatal ages of 31 (3.9) weeks, 1,486 (794) g, and 18 (14) days were enrolled over 30 months. Gastrointestinal symptoms were related to NEC in 23 patients and associated with other causes in 22. Analysis of the 48 hours of monitoring revealed comparable abdominal r-SO2 and splanchnic-cerebral oxygenation ratio (SCOR) in patients with and without NEC (r-SO2: 47.3 [20.4] vs. 50.4 [17.8], p = 0.59, SCOR: 0.64 [0.26] vs. 0.69 [0.24], p = 0.51). Results were unchanged after NIRS analysis in 6-hour periods, and restriction of the analysis to severe NEC (i.e., grade 2 and 3, 57% of the NEC cases). CONCLUSION In this study, NIRS monitoring was unable to individualize NEC in premature infants with acute gastrointestinal symptoms.
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Affiliation(s)
- Julia Le Bouhellec
- Neonatal Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Olivier Prodhomme
- Department of Pediatric Radiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Thibault Mura
- Department of Medical Information, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Aurélien Jacquot
- Neonatal Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Clémentine Combes
- Neonatal Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Lucie Gamon
- Department of Medical Information, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Sabine Durand
- Neonatal Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Anne Filleron
- Department of Pediatrics, Carémeau Hospital, Nîmes University Hospital Center, Nîmes, France
| | - Gilles Cambonie
- Neonatal Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
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Ilhan O, Bor M. Effects of Single Loading Dose of Intravenous Caffeine on Cerebral Oxygenation in Preterm Infants. Am J Perinatol 2021; 38:e116-e122. [PMID: 32198745 DOI: 10.1055/s-0040-1708490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of caffeine on cerebral oxygenation in preterm infants. STUDY DESIGN This was a prospective study of infants with a gestational age (GA) of < 34 weeks who were treated intravenously with a loading dose of 20 mg/kg caffeine citrate within the first 48 hours of life. Regional cerebral oxygen saturation (rSO2C) and cerebral fractional tissue oxygen extraction (cFTOE) were measured using near-infrared spectroscopy before administering caffeine (baseline), immediately after administering caffeine, and 1, 2, 3, 4, 6, and 12 hours after dose completion; postdose values were compared with the baseline values. RESULTS A total of 48 infants with a mean GA of 29.0 ± 1.9 weeks, birth weight of 1,286 ± 301 g, and postnatal age of 32.4 ± 11.3 hours were included in the study. rSO2C significantly decreased from 81.3 to 76.7% soon after administering caffeine, to 77.1% at 1 hour, and to 77.8% at 2 hours with recovery at 3 hours postdose. rSO2C was 80.2% at 12 hours postdose. cFTOE increased correspondingly. Although rSO2C values were lower and cFTOE values were higher compared with the baseline values at 3, 4, 6, and 12 hours after caffeine administration, this was not statistically significant. CONCLUSION A loading dose of caffeine temporarily reduces cerebral oxygenation and increases cerebral tissue oxygen extraction in preterm infants. Most probably these changes reflect a physiological phenomenon without any clinical importance to the cerebral hemodynamics, as the reduction in cerebral oxygenation and increase in cerebral tissue oxygen extraction remain well within acceptable range.
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Affiliation(s)
- Ozkan Ilhan
- Department of Neonatology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Meltem Bor
- Department of Neonatology, Harran University Faculty of Medicine, Sanliurfa, Turkey
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