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Condit PE, Chuck JE, Lasarev MR, Chock VY, Harer MW. Renal tissue oxygenation and development of AKI in preterm neonates born < 32 weeks' gestational age in the first week of age. J Perinatol 2024; 44:434-438. [PMID: 38233582 DOI: 10.1038/s41372-024-01873-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To evaluate the relationship between regional renal saturation of oxygen (RrSO2) changes and serum creatinine (SCr) during the first eight days of age for preterm neonates born < 32 weeks' gestational age. DESIGN Post-hoc analysis of multicenter prospectively measured neonatal RrSO2 values collected during the first 8 days of age in neonates born at < 32 weeks' gestation. Acute kidney injury (AKI) was defined by the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Variables were compared between groups of neonates with and with AKI. RESULTS One hundred nine neonates were included and 561 SCr values were obtained. Eight participants developed AKI by SCr criteria. A 10-percentage point increase in mean %RrSO2 was associated with a 40% decrease in risk of AKI (95%CI: 9.6-61%; p = 0.016). CONCLUSIONS Increases in mean %RrSO2 in neonates born at < 32 weeks' GA were associated with a decreased risk of AKI. These findings support the design of further prospective trials utilizing RrSO2 monitoring to evaluate new therapies or clinical protocols to prevent and treat neonatal AKI.
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Affiliation(s)
- Paige E Condit
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Jennifer E Chuck
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew W Harer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Zhao C, Sun Z, Chen H, Li K, Sun H. The impact of blood lactic acid levels on retinopathy of prematurity morbidity. BMC Pediatr 2024; 24:152. [PMID: 38424517 PMCID: PMC10902957 DOI: 10.1186/s12887-024-04571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a common disease in premature infants. In recent years, most researchers have used lactic acid as poor prognosis marker in premature infants. This study aims to explore investigate the impact of blood lactic acid levels on ROP. METHODS A retrospective case-control study was conducted, and infants with severe ROP born with birth weight (BW) ≤ 1500 g and gestational age (GA) ≤ 32 weeks were enrolled from November 2016 to November 2021. Infants without any stage ROP were included as controls and were matched with ROP infants (1:2) by GA and BW. All selected preterm infants were tested for heel terminal trace blood gas analysis within two weeks of life. Changes in blood lactic acid levels in the two groups were compared and analyzed by using multivariate logistic regression analysis. Sensitivity and specificity were analyzed by receiver operating characteristic (ROC) curve. RESULTS There were 79 infants in ROP group, and 158 infants in control group. The levels of blood lactic acid were significantly higher in the ROP group on days 1, 3, 5, and 7 compared with control group (all p < 0.05). The blood lactic acid levels on day 5 was an independent risk factor for ROP (p = 0.017). The area under the curve (AUC), sensitivity and specificity were highest on day 5 (AUC 0.716, sensitivity 77.2% and specificity 62.0%, respectively, p < 0.001), and higher on days 1, 3, and 7. CONCLUSION A high blood lactic acid level in the first seven days of life may be associated with increases ROP occurrence in very preterm infants, and suggest blood lactic acid level may impact the occurrence of ROP.
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Affiliation(s)
- Congcong Zhao
- Department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhihong Sun
- Department of Neonatology, Children's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhuwaihuan Road, Zhengzhou, 450018, China
| | - Hongming Chen
- Department of Neonatology, Zhecheng People's Hospital, Henan, China
| | - Kaili Li
- Department of Neonatology, Zhecheng People's Hospital, Henan, China
| | - Huiqing Sun
- Department of Neonatology, Children's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhuwaihuan Road, Zhengzhou, 450018, China.
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Jiang L, Yu Q, Wang F, Wu M, Liu F, Fu M, Gao J, Feng X, Zhang L, Xu Z. The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants. Front Pediatr 2023; 11:1241809. [PMID: 37876522 PMCID: PMC10590921 DOI: 10.3389/fped.2023.1241809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
Background Hemodynamic instability is the main factor responsible for the development of intraventricular hemorrhage (IVH) in premature newborns. Herein, we evaluated the predictive ability of blood pressure variability (BPV) and anterior cerebral artery (ACA) blood flow parameters in IVH in premature infants with gestational age (GA) ≤32 weeks and birth weight (BW) ≤ 1,500 g. Methods Preterm infants with GA ≤32 weeks and BW ≤ 1,500 g admitted to the neonatal intensive care unit (NICU) of the hospital affiliated to Yangzhou University from January 2020 to January 2023 were selected as the research subjects. All preterm infants were admitted within 1 h after birth, and systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) were monitored at 1-h intervals. The difference between maximum and minimum values (max-min), standard deviation (SD), coefficient of variation (CV), and successive variation (SV) were used as BPV indicators. On the 1st, 3rd, and 7th day after birth, transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 24 ± 1 h after birth, systolic velocity (Vs), diastolic velocity (Vd), and resistance index (RI) of the ACA were measured simultaneously. Preterm infants were divided into the IVH group and non-IVH group based on the results of transcranial ultrasound examination, and the correlation between BPV indicators, ACA blood flow parameters, and development of IVH was analyzed. Results A total of 92 premature infants were enrolled, including 49 in the IVH group and 43 in the non-IVH group. There was no statistically significant difference in baseline characteristics such as BW, GA, sex, and perinatal medical history between the two groups of preterm infants (P > 0.05). The SBP SD (OR: 1.480, 95%CI: 1.020-2.147) and ACA-RI (OR: 3.027, 95%CI: 2.769-3.591) were independent risk factors for IVH in premature newborns. The sensitivity and specificity of combined detection of SBP SD and ACA-RI in predicting IVH were 61.2% and 79.1%, respectively. Conclusion High BPV and ACA-RI are related to IVH in premature infants with GA ≤32 w and BW ≤1,500 g. Combined detection of SBP SD and ACA-RI has a certain predictive effect on early identification of IVH.
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Affiliation(s)
- Lijun Jiang
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qian Yu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Fudong Wang
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Mingfu Wu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Feng Liu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Mingfeng Fu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Junyan Gao
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Xing Feng
- Department of Neonatology, Affiliated Children's Hospital of Soochow University, Suzhou, China
| | - Longfeng Zhang
- Department of Clinical Laboratory, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhenxing Xu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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Sun Y, Gong JY. Dynamic Changes in Retinal Vessel Diameters and Arteriovenous Ratio within 10 Days of Birth. Curr Eye Res 2023; 48:492-497. [PMID: 36637454 DOI: 10.1080/02713683.2023.2165106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE This study monitored the dynamic changes in retinal vascular width and the AVR in full-term neonates within 1-10 days of birth. METHODS It was conducted at hospitals in the Anhui province from October 2020 to March 2022. A total of 700 full-term, healthy infants were chosen randomly within 10 days of birth, and the Star Pupil Medical Cloud Data System (XBDS) was used to collect fundus images. Infants within 6 days of birth were grouped into groups one to six, while those within the 7th to 10th days were grouped into group seven. The fundus photographs were imported into Image-Pro-Plus (IPP) software. The optic disc diameter was measured. The retinal artery and vein's diameter was measured at a distance between 0.5- and 1.0-disc diameter from the optic disc's margin. The AVR was also calculated. Finally, each group's retinal vessel diameters and AVR were compared separately to show their dynamic changes. RESULTS There were differences in the retinal artery diameter between groups one and two, three and four, four and five, and five and six. For retinal vein diameter, there were differences between groups one and two and groups six and seven. There were also differences in the AVR between all groups. In addition, there was a significant positive correlation between the small retinal artery and vein diameters. CONCLUSION The retinal artery and vein diameters and AVR in neonates change dynamically during the first 10 days of life. The AVR undergoes the most dramatic change daily and is considerably smaller than the AVR in adults. Hence, this study found that the external environment undergoes significant changes following birth that affect the microcirculation. Then, the retinal central vascular system undergoes similar emergency and adaptive alterations.
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Affiliation(s)
- Yue Sun
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jian Yang Gong
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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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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Barišić N. Assessment of Indicators of Left Ventricular Performance Obtained by Tissue Doppler Imaging in Prematurely Born Neonates. J Cardiovasc Dev Dis 2022; 9:jcdd9110364. [PMID: 36354763 PMCID: PMC9693410 DOI: 10.3390/jcdd9110364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Tissue Doppler imaging techniques (pulsed-wave TDI (pwTDI) and color-coded TDI (cTDI)) allow for the assessment of myocardial performance during the cardiac cycle. The application of such techniques in neonatology is sporadic and poorly studied. Objective: The objective of the present study was to determine average values of pwTDI indicators of left ventricular performance (maximum systolic velocity of the mitral annulus (s’), maximum velocity in early diastole (e’) and maximum velocity in late diastole (a’)) and to examine their dynamics in prematurely born newborns in the first week of life. Methods: Prematurely born newborns of postnatal age up to 7 days were divided by gestational age into Group1 (<28 weeks) and Group 2 (≥28 weeks). Standard pwTDI parameters (s’, e’ and a’) were measured, compared between the groups and correlated with gestational and postnatal age, as well as application of respiratory support. Results: Fifty subjects were included (Group 1: 24; Group 2: 26). Average values of parameters s’, e’ and a’ were: Group 1: 4.06 ± 0.78 cm/s, 3.71 ± 0.40 cm/s and 3.98 ± 1.06 cm/s, respectively; Group 2: 4.18 ± 1.22 cm/s, 4.68 ± 1.04 cm/s and 4.12 ± 0.94 cm/s, respectively. Values of parameter e’ differed significantly between groups (p = 0.001) and strongly correlated with gestational age (p = 0, Pearson’s R = 0.88). There was no significant difference between groups for parameters s’ and a’ (p = 0.42 and 0.31, respectively). The values of s’, e’ and a’ did not differ between patients with an without respiratory support. Conclusion: Parameter e’ depends on gestational age, whereas parameters s’ and a’ are independent of gestational age. pwTDI indicators do not change during the first week of life, nor are all robust to hemodynamic circumstances caused by invasive/non-invasive respiratory support.
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Affiliation(s)
- Nenad Barišić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; ; Tel.: +381-64-2115233
- Institute For Child and Youth Healthcare of Vojvodina, 21000 Novi Sad, Serbia
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Abstract
The measurement of blood pressure in the very low birth weight newborn infant is not simple and may be erroneous because of numerous factors. Assessment of cardiovascular insufficiency in this population should be based on multiple parameters and not only on numeric blood pressure readings. The decision to treat cardiovascular insufficiency should be made after considering the potential complications of such treatment. There are numerous potential strategies to avoid or mitigate hypoperfusion states in the very low birth weight infant.
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Affiliation(s)
- Jay P Goldsmith
- Department of Pediatrics, Division of Newborn Medicine, Tulane University, New Orleans, Louisiana
| | - Erin Keels
- Neonatal Practitioner Program, Neonatal Services, Nationwide Children's Hospital, Columbus, Ohio
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Tataranno ML, Vijlbrief DC, Dudink J, Benders MJNL. Precision Medicine in Neonates: A Tailored Approach to Neonatal Brain Injury. Front Pediatr 2021; 9:634092. [PMID: 34095022 PMCID: PMC8171663 DOI: 10.3389/fped.2021.634092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022] Open
Abstract
Despite advances in neonatal care to prevent neonatal brain injury and neurodevelopmental impairment, predicting long-term outcome in neonates at risk for brain injury remains difficult. Early prognosis is currently based on cranial ultrasound (CUS), MRI, EEG, NIRS, and/or general movements assessed at specific ages, and predicting outcome in an individual (precision medicine) is not yet possible. New algorithms based on large databases and machine learning applied to clinical, neuromonitoring, and neuroimaging data and genetic analysis and assays measuring multiple biomarkers (omics) can fulfill the needs of modern neonatology. A synergy of all these techniques and the use of automatic quantitative analysis might give clinicians the possibility to provide patient-targeted decision-making for individualized diagnosis, therapy, and outcome prediction. This review will first focus on common neonatal neurological diseases, associated risk factors, and most common treatments. After that, we will discuss how precision medicine and machine learning (ML) approaches could change the future of prediction and prognosis in this field.
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Affiliation(s)
| | | | | | - Manon J. N. L. Benders
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Van Wyk L, Smith J, Lawrenson J, Lombard CJ, de Boode WP. Bioreactance-derived haemodynamic parameters in the transitional phase in preterm neonates: a longitudinal study. J Clin Monit Comput 2021; 36:861-870. [PMID: 33983533 DOI: 10.1007/s10877-021-00718-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
Bioreactance (BR) is a novel, non-invasive technology that is able to provide minute-to-minute monitoring of cardiac output and additional haemodynamic variables. This study aimed to determine the values for BR-derived haemodynamic variables in stable preterm neonates during the transitional period. A prospective observational study was performed in a group of stable preterm (< 37 weeks) infants in the neonatal service of Tygerberg Children's Hospital, Cape Town, South Africa. All infants underwent continuous bioreactance (BR) monitoring until 72 h of life. Sixty three preterm infants with a mean gestational age of 31 weeks and mean birth weight of 1563 g were enrolled. Summary data and time series graphs were drawn for BR-derived heart rate, non-invasive blood pressure, stroke volume, cardiac output and total peripheral resistance index. All haemodynamic parameters were significantly associated with postnatal age, after correction for clinical variables (gestational age, birth weight, respiratory support mode). To our knowledge, this is the first paper to present longitudinal BR-derived haemodynamic variable data in a cohort of stable preterm infants, not requiring invasive ventilation or inotropic support, during the first 72 h of life. Bioreactance-derived haemodynamic monitoring is non-invasive and offers the ability to simultaneously monitor numerous haemodynamic parameters of global systemic blood flow. Moreover, it may provide insight into transitional physiology and its pathophysiology.
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Affiliation(s)
- Lizelle Van Wyk
- Division Neonatology, Dept. Pediatrics & Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa.
| | - Johan Smith
- Division Neonatology, Dept. Pediatrics & Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - John Lawrenson
- Pediatric Cardiology Unit, Dept. Pediatrics & Child Health, Stellenbosch University, Cape Town, South Africa
| | - Carl J Lombard
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Willem Pieter de Boode
- Division of Neonatology, Dept. of Perinatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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10
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Kooi EMW, Bos AF, Mintzer JP. Editorial: Organ Perfusion and Oxygenation in the Sick Infant. Front Pediatr 2021; 9:840917. [PMID: 35155323 PMCID: PMC8830284 DOI: 10.3389/fped.2021.840917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elisabeth M W Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Abstract
Near-infrared spectroscopy (NIRS) has been available in research and clinical practice for more than four decades. Recently, there have been numerous publications and substantial developments in the field. This article describes the clinical application of NIRS in relation to current guidelines, with a focus on pediatric and cardiac anesthesia. It discusses technical and physiological principles, pitfalls in clinical use and presents (patho)physiological influencing factors and derived variables, such as fractional oxygen extraction (FOE) and the cerebral oxygen index (COx). Recommendations for the interpretation of NIRS values in connection with influencing factors, such as oxygen transport capacity, gas exchange and circulation as well as an algorithm for cardiac anesthesia are presented. Limitations of the method and the lack of comparability of values from different devices as well as generally accepted standard values are explained. Technical differences and advantages compared to pulse oxymetry and transcranial Doppler sonography are illuminated. Finally, the prognostic significance and requirements for future clinical studies are discussed.
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12
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Bruckner M, Binder‐Heschl C, Schwaberger B, Mileder LP, Baik‐Schneditz N, Koestenberger M, Avian A, Urlesberger B, Pichler G. Cerebral and peripheral tissue oxygenation in stable neonates: Absent influence of cardiac function. Acta Paediatr 2020; 109:1560-1569. [PMID: 31943338 PMCID: PMC7383825 DOI: 10.1111/apa.15172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 01/08/2023]
Abstract
Aim Cardiac function is a major factor for tissue perfusion and therefore may affect the tissue oxygen saturation. Aim was to analyse possible associations between cardiac function parameters and cerebral and peripheral tissue oxygenation in neonates on the first day after birth. Methods For the present study, we analysed secondary outcome parameters of a previously performed prospective single centre observational study. The prospective study was conducted at the Medical University of Graz, Austria between September 2011 and June 2013. We included preterm and term neonates who were admitted to the neonatal intensive care unit and in whom simultaneous near‐infrared spectroscopy measurements and echocardiography were obtained on the first day after birth. Cardiac function parameters were correlated to cerebral and peripheral tissue oxygen saturation and cerebral and peripheral fractional tissue oxygen extraction at the time of echocardiography. Results A total of 60 neonates of whom 47 were preterm and 13 were term (median gestational age: 34; IQR 33‐35 weeks, mean birth weight: 2276 ± 774 grams) were included. There were no statistically significant correlations between cardiac function parameters and regional tissue oxygenation parameters. Conclusion In the present study, we found no correlation between regional tissue oxygenation and parameters of cardiac function in cardio‐circulatory stable neonates on the first day after birth.
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Affiliation(s)
- Marlies Bruckner
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Corinna Binder‐Heschl
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Bernhard Schwaberger
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Lukas Peter Mileder
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Nariae Baik‐Schneditz
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology Department of Paediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - Berndt Urlesberger
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
| | - Gerhard Pichler
- Research Unit for Neonatal Micro‐ and Macrocirculation Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
- Division of Neonatology Department of Pediatrics and Adolescent Medicine Medical University of Graz Graz Austria
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13
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Vik SD, Torp H, Follestad T, Støen R, Nyrnes SA. NeoDoppler: New ultrasound technology for continous cerebral circulation monitoring in neonates. Pediatr Res 2020; 87:95-103. [PMID: 31404920 DOI: 10.1038/s41390-019-0535-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/13/2019] [Accepted: 07/25/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a strong need for continuous cerebral circulation monitoring in neonatal care, since suboptimal cerebral blood flow may lead to brain injuries in preterm infants and other critically ill neonates. NeoDoppler is a novel ultrasound system, which can be gently fixed to the anterior fontanel and measure cerebral blood flow velocity continuously in different depths of the brain simultaneously. We aimed to study the feasibility, accuracy, and potential clinical applications of NeoDoppler in preterm infants and sick neonates. METHOD Twenty-five infants born at different gestational ages with a variety of diagnoses on admission were included. The probe was placed over the anterior fontanel, and blood flow velocity data were continuously recorded. To validate NeoDoppler, we compared the measurements with conventional ultrasound; agreement was assessed using Bland-Altman plots. RESULTS NeoDoppler can provide accurate and continuous data on cerebral blood flow velocity in several depths simultaneously. Limits of agreement between the measurements obtained with the two methods were acceptable. CONCLUSION By monitoring the cerebral circulation continuously, increased knowledge of cerebral hemodynamics in preterm infants and sick neonates may be acquired. Improved monitoring of these vulnerable brains during a very sensitive period of brain development may contribute toward preventing brain injuries.
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14
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Mintzer JP, Moore JE. Regional tissue oxygenation monitoring in the neonatal intensive care unit: evidence for clinical strategies and future directions. Pediatr Res 2019; 86:296-304. [PMID: 31247635 DOI: 10.1038/s41390-019-0466-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 12/19/2022]
Abstract
Near-infrared spectroscopy (NIRS)-based monitoring of regional tissue oxygenation (rSO2) is becoming more commonplace in the neonatal intensive care unit (NICU). While increasing evidence supports rSO2 monitoring, actual standards for applying this noninvasive bedside technique continue to evolve. This review highlights the current strengths and pitfalls surrounding practical NIRS-based monitoring in the neonatal population. The physiologic background of rSO2 monitoring is discussed, with attention to understanding oxygen delivery/consumption mismatch and its effects on tissue oxygen extraction. The bedside utility of both cerebral and peripheral rSO2 monitoring in the NICU is then explored from two perspectives: (1) disease/event-specific "responsive" monitoring and (2) "routine," continuous monitoring. Recent evidence incorporating both monitoring approaches is summarized with emphasis on practical applicability in the NICU. Finally, a future paradigm for a broad-based NIRS monitoring strategy is presented, with attention towards improving personalization of neonatal care and ultimately enhancing long-term outcomes.
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Abstract
Preterm neonates often have hypotension which may be due to various etiologies. While it is controversial to define hypotension in preterm neonates, various vasoactive medications are commonly used to provide the cardiovascular support to improve the blood pressure, cardiac output, or to treat shock. However, the literature on the systemic and regional hemodynamic effects of these antihypotensive medications in neonates is deficient and incomplete, and cautious translation of findings from other clinical populations and animal studies is required. Based on a literature search on published reports, meta-analytic reviews, and selected abstracts, this review discusses the current available information on pharmacologic actions, clinical effects, and side effects of commonly used antihypotensive medications including dopamine, dobutamine, epinephrine, norepinephrine, vasopressin, and milrinone in preterm neonates.
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Affiliation(s)
- Chloe Joynt
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, 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
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Joynt C, Cheung PY. Cardiovascular Supportive Therapies for Neonates With Asphyxia - A Literature Review of Pre-clinical and Clinical Studies. Front Pediatr 2018; 6:363. [PMID: 30619782 PMCID: PMC6295641 DOI: 10.3389/fped.2018.00363] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/08/2018] [Indexed: 12/13/2022] Open
Abstract
Asphyxiated neonates often have hypotension, shock, and poor tissue perfusion. Various "inotropic" medications are used to provide cardiovascular support to improve the blood pressure and to treat shock. However, there is incomplete literature on the examination of hemodynamic effects of these medications in asphyxiated neonates, especially in the realm of clinical studies (mostly in late preterm or term populations). Although the extrapolation of findings from animal studies and other clinical populations such as children and adults require caution, it seems appropriate that findings from carefully conducted pre-clinical studies are important in answering some of the fundamental knowledge gaps. Based on a literature search, this review discusses the current available information, from both clinical studies and animal models of neonatal asphyxia, on common medications used to provide hemodynamic support including dopamine, dobutamine, epinephrine, milrinone, norepinephrine, vasopressin, levosimendan, and hydrocortisone.
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Affiliation(s)
- Chloe Joynt
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pharmacology, University of Alberta, Edmonton, AB, Canada.,Centre for the Study of Asphyxia and Resuscitation, Edmonton, AB, Canada
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