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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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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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Bailey SM, Mally PV. Near-Infrared Spectroscopy to Guide and Understand Effects of Red Blood Cell Transfusion. Clin Perinatol 2023; 50:895-910. [PMID: 37866855 DOI: 10.1016/j.clp.2023.07.006] [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: 10/24/2023]
Abstract
This review is a summary of available evidence regarding the use of near-infrared spectroscopy (NIRS) to help better guide and understand the effects of red blood cell (RBC) transfusion in neonatal patients. We review recent literature demonstrating the changes that take place in regional tissue oxygen saturation (rSO2) resulting from RBC transfusion. We also discuss in detail if any correlation exists between rSO2 and hemoglobin values in neonates. Finally, we review studies that have evaluated the use of NIRS as a transfusion guide during neonatal intensive care.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital NYU Langone, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital NYU Langone, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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Downey LA, Goobie SM. Regional Tissue Oximetry in Pediatric Patient Blood Management: A New Physiologic Tool in the Transfusion Toolbox? Anesth Analg 2023; 137:983-986. [PMID: 37862400 DOI: 10.1213/ane.0000000000006608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Laura A Downey
- From the Department of Anesthesiology, Emory University Medical School, Children's Healthcare of Atlanta
| | - Susan M Goobie
- Harvard Medical School
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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Surma VJ, Patel A, Ng DK, Goswami DK, Garcia AV, Bembea MM. Effect of Red Blood Cell Transfusion on Regional Tissue Oxygenation in Pediatric Cardiac Surgery Patients. Anesth Analg 2023; 137:987-995. [PMID: 37036824 PMCID: PMC10562511 DOI: 10.1213/ane.0000000000006479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Red blood cell (RBC) transfusions are used frequently in pediatric patients admitted to the intensive care unit (ICU) after cardiac surgery. To improve data-driven transfusion decision-making in the ICU, we conducted a retrospective analysis to assess the effect of RBC transfusion on cerebral and somatic regional oxygenation (rSO2). METHODS We evaluated post- versus pre-RBC transfusion cerebral rSO2 and somatic rSO2 in all consecutive pediatric patients (age >28 days to <18 years) who underwent biventricular cardiac surgery at a single center between July 2016 and April 2020. RESULTS The final data set included 263 RBC postoperative transfusion events in 75 patients who underwent 83 surgeries. The median pretransfusion hemoglobin was 10.6 g/dL (25th-75th percentile, 9.3-11.6). The median pretransfusion cerebral and somatic rSO2 were 63% (54-71) and 69% (55-80), which increased by a median of 3 percentage points (-2 to 6) and 2 percentage points (-3 to 6), respectively, after transfusion. After adjusting for pretransfusion hemoglobin, change in hemoglobin posttransfusion versus pretransfusion, and potential confounders (age, sex, and STAT surgical mortality risk score), the posttransfusion versus pretransfusion change in cerebral or somatic rSO2 was not statistically significant. Pretransfusion cerebral rSO2 (crSO2) was ≤50%, a previously described threshold for increased risk for unfavorable neurological outcome, for 22 of 138 (16%) transfusion events with complete pre- and post-crSO2 data. Sixteen of these 22 (73%) transfusions resulted in a posttransfusion crSO2 >50%. When restricting analysis to the first (index) transfusion after arrival to the ICU from the operating room (administered at a median of 1.15 postoperative days [25th-75th percentile, 0.84-1.93]), between-patient pretransfusion hemoglobin was not associated with pretransfusion crSO2 but within-patient posttransfusion versus pretransfusion hemoglobin difference was significantly associated with posttransfusion versus pretransfusion crSO2 difference (mean posttransfusion versus pretransfusion crSO2 difference, 2.54; 95% confidence interval, 0.50-4.48). CONCLUSIONS In this study, neither cerebral nor somatic rSO2 increased significantly post- versus pre-RBC transfusion in pediatric cardiac surgery patients admitted to the ICU after biventricular repairs. However, almost three-quarters of transfusions administered when pretransfusion crSO2 was below the critical threshold of 50% resulted in a posttransfusion crSO2 >50%. In addition, the significant within-patient change in crSO2 in relation to the change in posttransfusion versus pretransfusion hemoglobin in the immediate postoperative period suggests that a personalized approach to transfusion following within-patient trends of crSO2 rather than absolute between-patient values may be an important focus for future research.
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Affiliation(s)
- Victoria J Surma
- From the Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ankur Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Dheeraj K Goswami
- From the Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro V Garcia
- Department of Surgery (Pediatric), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melania M Bembea
- From the Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Noroozi-Clever MB, Liao SM, Whitehead HV, Vesoulis ZA. Preterm Infants off Positive Pressure Respiratory Support Have a Higher Incidence of Occult Cerebral Hypoxia. J Pediatr 2023; 262:113648. [PMID: 37517651 PMCID: PMC10822026 DOI: 10.1016/j.jpeds.2023.113648] [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: 10/14/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To use cerebral near-infrared spectroscopy (NIRS) to quantify occult cerebral hypoxia across respiratory support modes in preterm infants. STUDY DESIGN In this prospective, longitudinal, observational study, infants ≤32 weeks gestation underwent serial pulse oximetry (oxygen saturation [SpO2]) and cerebral NIRS monitoring (4-6 hours per session) following a standardized recording schedule (daily for 2 weeks, every other day for 2 weeks, then weekly until 35 weeks corrected gestational age). Four calculations were made: median cerebral saturation, median cerebral hypoxia burden (proportion of NIRS samples below the hypoxia threshold [<67%]), median systemic saturation, and median systemic hypoxia burden (proportion of SpO2 samples below the desaturation threshold [<85%]). During each recording session, respiratory support mode was noted (room air, low-flow nasal cannula, high-flow nasal cannula, noninvasive positive pressure ventilation, continuous positive airway pressure, and invasive ventilation). RESULTS There were 1013 recording sessions made from 174 infants with a median length of 6.9 hours. Although the systemic (SpO2) hypoxia burden was significantly greater for infants on the highest respiratory support (invasive and noninvasive positive pressure ventilation), the cerebral hypoxia burden was significantly greater during recording sessions made on the lowest respiratory support (8% for room air; 29% for low-flow nasal cannula). CONCLUSIONS Premature infants on the highest levels of respiratory support have less cerebral hypoxia than those on lower respiratory support. These results raise concern about unrecognized cerebral hypoxia during lower acuity periods of neonatal intensive care unit hospitalization and adverse outcomes.
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Affiliation(s)
- Mona B Noroozi-Clever
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Steve M Liao
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Halana V Whitehead
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
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Mu Y, Wang H, Tian M, Hu Y, Feng Y, Lu R, He Q, Jiang S, Huang J, Duan S, Mu D. Cross-sectional association between red blood cell distribution width and regional cerebral tissue oxygen saturation in preterm infants in the first 14 days after birth. Front Pediatr 2023; 11:1238762. [PMID: 38027304 PMCID: PMC10644271 DOI: 10.3389/fped.2023.1238762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hypoxia can threaten the metabolic functions of different systems in immature neonates, particularly the central nervous system. The red blood cell distribution width (RDW) has recently been reported as a prognostic factor in neurologic diseases. Herein, we examined the correlation between RDW and regional cerebral tissue oxygen saturation (rcSO2). Methods This cross-sectional study included 110 preterm infants born at a gestational age (GA) of <32 weeks, or with a birth weight (BW) of <1,500 g at our institution between January and June 2,022. The rcSO2 was monitored using near-infrared spectroscopy, and RDW was extracted from the complete blood count during the first 14 days after birth. RDW and rcSO2 measurements were analyzed using a cross-sectional research method. Results We divided the study population into two groups, with a mean rcSO2 value over the first 14 days. Fifty-three preterm had rcSO2 ≥ 55% and 57% < 55%. The 14-days-mean in the study population showing an association of lower rcSO2 values with higher RDW values. Significantly higher RDW values were observed in the low rcSO2 group compared with those in the high rcSO2 group. Threshold effect analysis showed that rcSO2 decreased with RDW values ≥18% (β, -0.03; 95% CI, -0.04 and -0.02; p ≥ 0.0001). After adjusting for potential confounders, an RDW of ≥18% was determined as the predictive cutoff value for preterm infants with low rcSO2 (Model I: OR, 3.31; 95% CI, 1.36-8.06; p = 0.009; and Model II: OR, 3.31; 95% CI, 1.28-8.53; p = 0.013). Conclusions An RDW of ≥18% in the first 14 days is associated with rcSO2 of <55% in preterm infants.
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Affiliation(s)
- Yuju Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Mengting Tian
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yong Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yi Feng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Ruifeng Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Qi He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Shouliang Jiang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jinglan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Surong Duan
- Department of Clinical Medicine, BinZhou Medical College, Yantai, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
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Holzapfel LF, Rysavy MA, Bell EF. Red Blood Cell Transfusion Thresholds for Anemia of Prematurity. Neoreviews 2023; 24:e370-e376. [PMID: 37258497 PMCID: PMC10865726 DOI: 10.1542/neo.24-6-e370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Anemia of prematurity affects the majority of preterm infants, particularly extremely low birthweight infants. Anemia of prematurity arises from both innate and iatrogenic causes and results in more than 80% of extremely preterm infants receiving red blood cell transfusions during the first month after birth. Multiple randomized controlled trials were conducted to evaluate the effect of using lower versus higher transfusion thresholds based on hemoglobin levels. These trials showed no difference in the primary outcome of neurodevelopmental impairment at 2 years of age between lower and higher thresholds. However, some uncertainties about transfusion thresholds remain. This review elaborates the following: 1) the etiology, prevention, and treatment of anemia of prematurity with a focus on red blood cell transfusions, 2) the history of randomized controlled trials on the treatment of anemia of prematurity, and 3) limitations of the evidence and remaining questions about thresholds for red blood cell transfusions in preterm infants.
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Affiliation(s)
- Lindsay F Holzapfel
- McGovern Medical School at University of Texas Health Science Center, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Matthew A Rysavy
- McGovern Medical School at University of Texas Health Science Center, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
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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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Perioperative Pediatric Erythrocyte Transfusions: Incorporating Hemoglobin Thresholds and Physiologic Parameters in Decision-making. Anesthesiology 2022; 137:604-619. [PMID: 36264089 DOI: 10.1097/aln.0000000000004357] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article presents current literature and scientific evidence on hemoglobin thresholds and physiologic parameters to guide decisions regarding perioperative erythrocyte transfusions in pediatric patients based on the most up-to-date studies and expert consensus recommendations.
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Vesoulis Z, Hopper A, Fairchild K, Zanelli S, Chalak L, Noroozi M, Liu J, Chock V. A phase-II clinical trial of targeted cerebral near infrared spectroscopy using standardized treatment guidelines to improve brain oxygenation in preterm infants (BOx-II): A study protocol. Contemp Clin Trials 2022; 120:106886. [PMID: 35995129 PMCID: PMC9489653 DOI: 10.1016/j.cct.2022.106886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mortality and brain injury are common adverse outcomes in infants born <28 weeks. Conventional pulse oximetry may not detect subclinical changes prior to deterioration and fails to detect changes within the brain. Increasing evidence supports the use of cerebral near-infrared spectroscopy (NIRS) in the early care of preterm infants, yet the impact of specific interventions on cerebral oxygenation and the relationship between cerebral hypoxia and brain injury on MRI remain to be determined. METHODS/DESIGN 100 infants <28 completed weeks of gestation will be recruited for a prospective, multicenter intervention trial. After informed consent, infants will undergo cerebral NIRS monitoring starting within 6 h of birth and continuing through 72 h. Infants with persistent cerebral desaturation will receive interventions following a standard treatment algorithm selected by the provider based on the patient's clinical condition. Providers will record the timing and choice of intervention(s) and term equivalent brain MRI will be performed for survivors. There are three objectives of this study: 1) to identify the relationship between cerebral hypoxia burden and brain injury on term-equivalent MRI. 2) to identify most common interventions after cerebral hypoxia, and 3) to quantify frequency of occult cerebral hypoxia events. DISCUSSION There is increasing evidence for the role of early cerebral NIRS monitoring in the neuroprotective care of preterm infants. This phase-II trial will provide essential data to improve the intervention approach, model the effect size of interventions on a wider extent of brain injury, and quantify the discrepancy between measurements of systemic and cerebral hypoxia.
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Affiliation(s)
| | - Andrew Hopper
- Loma Linda University, Loma Linda, CA, United States of America
| | - Karen Fairchild
- University of Virginia, Charlottesville, VA, United States of America
| | - Santina Zanelli
- University of Virginia, Charlottesville, VA, United States of America
| | - Lina Chalak
- University of Texas Southwest, Dallas, TX, United States of America
| | - Mona Noroozi
- Washington University, St. Louis, MO, United States of America
| | - Jessica Liu
- Stanford University, Palo Alto, CA, United States of America
| | - Valerie Chock
- Stanford University, Palo Alto, CA, United States of America
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Zima BT, Devaskar SU, Patel M, Raphael J, Pursley D, Keller D, Cheng T, Javier J, Lee L. Imperative to accelerate research aligning real-time clinical demand with mental health supply. Pediatr Res 2022; 92:917-920. [PMID: 36104514 PMCID: PMC9472179 DOI: 10.1038/s41390-022-02246-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Bonnie T. Zima
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA USA ,Pediatric Policy Council, Washington, DC USA
| | - Sherin U. Devaskar
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA USA ,Pediatric Policy Council, Washington, DC USA
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