Acid base and metabolic parameters of the umbilical cord blood and cerebral oxygenation immediately after birth

Objective

Aim was to investigate whether acid-base and metabolic parameters obtained from arterial umbilical cord blood affect cerebral oxygenation after birth in preterm neonates with respiratory support and in term neonates without respiratory support.

Study design

This was a post-hoc analysis of secondary outcome parameters of a prospective observational study including preterm neonates with and term neonates without respiratory support. Non-asphyxiated neonates with cerebral oxygenation measured with near-infrared spectroscopy during the first 15 min and with blood gas analyses from arterial umbilical cord blood were included. Arterial oxygen saturation (SpO2) and heart rate (HR) were monitored with pulse oximetry. Potential correlations were investigated between acid-base and metabolic parameters (pH-value, bicarbonate, base-excess, and lactate) and crSO2/cFTOE 5 min after birth.

Results

Seventy-seven neonates were included: 14 preterm neonates with respiratory support (mean gestational age [GA] 31.4 ± 4.1 weeks; mean birth weight [BW] 1,690 ± 640 g) and 63 term neonates without respiratory support (GA 38.7 ± 0.8 weeks; BW 3,258 ± 443 g). Mean crSO2 5 min after birth was 44.0% ± 24.2% in preterm and 62.2% ± 20.01% in term neonates. Mean cFTOE 5 min after birth was 0.46 ± 0.06 in preterm and 0.27 ± 0.19 in term neonates. In preterm neonates with respiratory support higher lactate was significantly associated with lower crSO2 and SpO2 and tended to be associated with higher cFTOE. In term neonates without respiratory support no significant correlations were found.

Conclusion

In non-asphyxiated preterm neonates with respiratory support, lactate levels were negatively associated with crSO2 and SpO2, whereas in term neonates without respiratory support no associations were observed.

Sustained decrease in latent safety threats through regular interprofessional in situ simulation training of neonatal emergencies

Simulation training at trainees' actual workplace offers benefits over traditional simulation-based team training. We prospectively investigated whether regular in situ simulation training of neonatal emergencies in an interprofessional and interdisciplinary team could be used to identify and rectify latent safety threats (LSTs).For this purpose, we conducted 1-day in situ simulation trainings at the Department of Gynaecology and Obstetrics, Feldbach, Austria, targeting anaesthesiologists, obstetricians, midwives, nurses and consultant paediatricians. Using published criteria for categorising LSTs, we collected LSTs, either recognised by trainers or training participants, categorised them qualitatively (medication, equipment, resource/system) and based on their potential for harm, discussed them with training participants, and reported them to hospital leadership.We conducted 13 trainings between June 2015 and April 2023, identifying 67 LSTs, most in the category of equipment (42/67, 62.7%), followed by resource/system (14/67, 20.9%) and medication (11/67, 16.4%). Sixty-one (91.0%) of the LSTs could be rectified by the next training. We observed a significant negative correlation between the number of delivered trainings and the frequency of identified LSTs (Pearson correlation coefficient r= -0,684, p=0.01).While we identified a higher number of LSTs in comparison to previously published studies, regular in situ simulation training of neonatal emergencies over a period of almost 8 years positively impacted patient safety, as the majority of LSTs was rectified by the next training. Even more important, the decrease in LSTs with the increasing number of delivered in situ simulation trainings underlines the sustained effect of this educational intervention.

Peripheral muscle fractional tissue oxygen extraction in stable term and preterm neonates during the first 24 h after birth

Background

Peripheral muscle fractional tissue oxygen extraction (pFTOE) represents the relative extraction of oxygen from the arterial to venous compartment, providing information about dynamic changes of oxygen delivery and oxygen consumption. The aim of the present study was to establish reference values of pFTOE during the first 24 h after birth in stable term and late preterm neonates.

Methods

The present study is a post-hoc analysis of secondary outcome parameters of prospective observational studies. Only stable neonates without infection, asphyxia and any medical support were eligible for our analysis to obtain normal values. For measurements of peripheral muscle tissue oxygenation index (pTOI) during the first 24 h after birth in term and preterm neonates, the NIRO200/NIRO200NX was used. Arterial oxygen saturation (SpO2) was obtained by pulse oximetry. pFTOE was calculated out of pTOI and SpO2: pFTOE = (SpO2-pTOI)/SpO2. Measurements of neonates were stratified into four groups according to their respective measurement time point (6 h periods) after birth. Term and preterm neonates were analyzed separately. Mean values of measurements during the first time period (0-6 h after birth) were compared to measurements of the following time periods (second = 7-12 h, third = 13-18 h, fourth = 19-24 h after birth).

Results

Two-hundred-fourty neonates (55 term and 185 late preterm neonates) had at least one peripheral muscle NIRS measurements within the first 24 h after birth. Mean gestational age and birth weight were 39.4 ± 1.1 weeks and 3360 (2860-3680)g in term neonates and 34.0 ± 1.4 weeks and 2060 (1750-2350)g in preterm neonates, respectively. In term neonates pFTOE was 0.264 (0.229-0.300), 0.228 (0.192-0.264), 0.237 (0.200-0.274) and 0.220 (0.186-0.254) in the first, second, third and fourth time period. In preterm neonates pFTOE was 0.229 (0.213-0.246), 0.225 (0.209-0.240), 0.226 (0.210-0.242) and 0.238 (0.222-0.255) in the first, second, third and fourth time period. pFTOE did not show any significant changes between the time periods, neither in term nor in preterm neonates.

Conclusion

We provide reference values of pFTOE for stable term and late preterm neonates within the first 24 h after birth, which were stable when comparing four 6-h periods. These normal values are of great need for interpreting pFTOE in scientific context as well as for potential future clinical applications.

Insights into Neonatal Cerebral Autoregulation by Blood Pressure Monitoring and Cerebral Tissue Oxygenation: A Qualitative Systematic Review

OBJECTIVE

The aim of this qualitative systematic review was to identify publications on blood pressure monitoring in combination with cerebral tissue oxygenation monitoring during the first week after birth focusing on cerebral autoregulation.

METHODS

A systematic search was performed on PubMed. The following search terms were used: infants/newborn/neonates, blood pressure/systolic/diastolic/mean/MAP/SAP/DAP, near-infrared spectroscopy, oxygenation/saturation/oxygen, and brain/cerebral. Additional studies were identified by a manual search of references in the retrieved studies and reviews. Only human studies were included.

RESULTS

Thirty-one studies focused on preterm neonates, while five included preterm and term neonates. In stable term neonates, intact cerebral autoregulation was shown by combining cerebral tissue oxygenation and blood pressure during immediate transition, while impaired autoregulation was observed in preterm neonates with respiratory support. Within the first 24 h, stable preterm neonates had reduced cerebral tissue oxygenation with intact cerebral autoregulation, while sick neonates showed a higher prevalence of impaired autoregulation. Further cardio-circulatory treatment had a limited effect on cerebral autoregulation. Impaired autoregulation, with dependency on blood pressure and cerebral tissue oxygenation, increased the risk of intraventricular hemorrhage and abnormal neurodevelopmental outcomes.

CONCLUSIONS

Integrating blood pressure monitoring with cerebral tissue oxygenation measurements has the potential to improve treatment decisions and optimizes neurodevelopmental outcomes in high-risk neonates.

Cardiac output and regional-cerebral-oxygen-saturation in preterm neonates during immediate postnatal transition: An observational study

AIM

To examine potential correlations between cardiac output (CO) with cerebral-regional-oxygen-saturation (crSO₂ ) and cerebral-fractional-tissue-oxygen-extraction (cFTOE) during immediate foetal-to-neonatal transition in term and preterm neonates with and without respiratory support.

METHODS

Post hoc analyses of secondary outcome parameters of prospective observational studies were performed. We included neonates with cerebral near-infrared-spectroscopy (NIRS) monitoring and an oscillometric blood pressure measurement at minute 15 after birth. Heart rate (HR) and arterial oxygen saturation (SpO₂ ) were monitored. CO was calculated with Liljestrand and Zander formula and correlated with crSO₂ and cFTOE.

RESULTS

Seventy-nine preterm neonates and 207 term neonates with NIRS measurements and calculated CO were included. In 59 preterm neonates (mean gestational age (GA): 29.4 ± 3.7 weeks) with respiratory support, CO correlated significantly positively with crSO₂ and significantly negatively with cFTOE. In 20 preterm neonates (GA 34.9 ± 1.3 weeks) without respiratory support and in 207 term neonates with and without respiratory support, CO correlated neither with crSO₂ nor with cFTOE.

CONCLUSION

In compromised preterm neonates with lower gestational age and in need of respiratory support, CO was associated with crSO₂ and cFTOE, whereas in stable preterm neonates with higher gestational age as well as in term neonates with and without respiratory support, no associations were observed.

Acid-base and metabolic parameters and cerebral oxygenation during the immediate transition after birth-A two-center observational study

OBJECTIVE

The association between blood glucose level and cerebral oxygenation (cerebral regional oxygen saturation [crSO2] and cerebral fractional tissue oxygen extraction [FTOE]) in neonates has already been described. Aim of the present study was to investigate if acid-base and other metabolic parameters have an impact on cerebral oxygenation immediately after birth in preterm and term neonates.

STUDY DESIGN

Post-hoc analyses of secondary outcome parameters of two prospective observational studies were performed. Preterm and term neonates born by caesarean section were included, in whom i) cerebral near-infrared spectroscopy (NIRS) measurements were performed during the first 15 minutes after birth and ii) a capillary blood gas analysis was performed between 10 and 20 minutes after birth. Vital signs were routinely monitored with pulse oximetry (arterial oxygen saturation [SpO2] and heart rate [HR]). Correlation analyses were performed to investigate potential associations between acid-base and metabolic parameters (lactate [LAC], pH-value [pH], base-excess [BE] and bicarbonate [HCO3]) from capillary blood and NIRS-derived crSO2 and FTOE at 15 minutes after birth.

RESULTS

One-hundred-fifty-seven neonates, 42 preterm neonates (median gestational age [IQR] 34.0 weeks [3.3], median birth weight 1845g [592]) and 115 term neonates (median gestational age [IQR] 38.9 weeks [1.0], median birth weight 3230g [570]) were included in the study. Median crSO2 [IQR] values at 15 minutes after birth were 82% [16] in preterm neonates and 83% [12] in term neonates. Median FTOE [IQR] values at 15 minutes after birth were 0.13 [0.15] in preterm neonates and 0.14 [0.14] in term neonates. In preterm neonates, higher LAC and lower pH and BE were associated with lower crSO2 and higher FTOE. In term neonates, higher HCO3 was associated with higher FTOE.

CONCLUSION

There were significant associations between several acid-base and metabolic parameters and cerebral oxygenation in preterm neonates, while in term neonates only HCO3 correlated positively with FTOE.

Fetal to neonatal transition: what additional information can be provided by cerebral near infrared spectroscopy?

This narrative review focuses on the clinical use and relevance of cerebral oxygenation measured by NIRS during fetal to neonatal transition. Cerebral NIRS(cNIRS) offers the possibility of non-invasive, continuous, and objective brain monitoring in addition to the recommended routine monitoring. During the last decade, with growing interest in early and sensitive brain monitoring, many research groups worldwide have been working with cNIRS and verified the feasibility of cNIRS monitoring immediately after birth. Cerebral hypoxia during fetal to neonatal transition, defined as cerebral oxygenation values below10th percentile, seems to have an impact on neurological outcomes. Feasibility to guide clinical support using cNIRS to reduce the burden of cerebral hypoxia has been shown. It is well known that in some cases cerebral oxygenation follows different patterns than SpO2. Cerebral oxygenation does not only depend on systemic oxygenation, hemoglobin content and cerebral blood flow, but also on cardiocirculatory condition, ventilation, and metabolic parameters. Hence, measurement of cerebral oxygenation may uncover problems not detectable by standard monitoring. Therefore, applying NIRS can provide caregivers a more complete clinical overview, especially in critically ill neonates. In this review, we aim to describe the additional information which can be provided by cNIRS during fetal to neonatal transition. IMPACT: This narrative review focuses on the clinical use and relevance of cerebral oxygenation measured by near infrared spectroscopy (NIRS) during fetal to neonatal transition. During the last decade, interest on brain monitoring is growing continuously as the measurement of cerebral oxygenation may uncover problems which are not detectable by routine monitoring. Therefore, it will be crucial to have additional information to get a complete overview, especially in critically ill neonates in need of medical and respiratory support. In this review, we offer additional information which can be provided by cerebral NIRS during fetal to neonatal transition.

Acid base and blood gas analysis in term neonates immediately after birth with uncomplicated neonatal transition

BACKGROUND

Acid base and blood gas measurements provide essential information, especially in critically ill neonates. After birth, rapidly changing physiology and difficulty to obtain blood samples represent unique challenges.

OBJECTIVES

The aim of the present study was to establish normal values of capillary acid base and blood gas analysis immediately after birth in term neonates after uncomplicated neonatal transition.

METHOD

This is a post-hoc-analysis of ancillary outcome parameter of a prospective observational study in term neonates immediately after caesarean section. Neonates were included after immediate neonatal transition without need of medical support and a capillary blood sample was taken by a heel-stick within 15-20 minutes after birth.

RESULT

One hundred thirty-two term neonates were included with mean (SD) gestational age of 38.7 ± 0.7 weeks. The blood was drawn mean (SD) 16 ± 1.7 minutes after birth. The mean (SD) values of the analyses were: pH 7.30 ± 0.04, pCO₂ 52.6 ± 6.4, base excess - 0.9 ± 1.7 and bicarbonate 24.8 ± 1.6.

CONCLUSION

This is the first study describing acid base and blood gas analyses in term neonates immediately after birth with uncomplicated neonatal transition.

Non-invasively Measured Venous Oxygen Saturation as Early Marker of Impaired Oxygen Delivery in Preterm Neonates

INTRODUCTION

Adequate oxygen supply for preterm neonates may be defined through non-invasive measurement of venous oxygen saturation (SvO₂) and fractional oxygen extraction using near-infrared spectroscopy (NIRS). We investigated whether there was a difference in peripheral muscle SvO₂ (pSvO₂) and peripheral fractional oxygen extraction (pFOE) in preterm neonates with early inflammation/infection compared to healthy subjects during the first 72 h after birth.

MATERIALS AND METHODS

We retrospectively analyzed secondary outcome parameters of prospective observational studies, including preterm neonates at risk of infection in whom peripheral NIRS measurements were performed in combination with venous occlusions. Early neonatal inflammation/infection was diagnosed by clinical signs and laboratory parameters. Peripheral muscle tissue oxygenation index (pTOI) was measured using either NIRO 300 or NIRO 200-NX (both Hamamatsu Photonics, Japan) on the patients' lower legs. Using 20-s venous occlusions, pSvO₂ and pFOE were calculated incorporating simultaneous measurements of arterial oxygen saturation (SpO₂).

RESULTS

We analyzed measurements from 226 preterm neonates (median gestational age 33.9 weeks), 64 (28.3%) of whom were diagnosed with early neonatal inflammation/infection. During the first 24 h after birth, pSvO₂ (66.9% [62.6-69.2] vs. 69.4% [64.6-72.0]; p = 0.04) and pTOI (68.6% [65.3-71.9] vs. 71.7% [67.3-75.1]; p = 0.02) were lower in those neonates with inflammation/infection, while there was no such difference for measurements between 24-48 and 48-72 h.

DISCUSSION

NIRS measurement of pSvO₂ and pFOE is feasible and may be utilized for early detection of impaired peripheral oxygen delivery. As pTOI was also significantly lower, this parameter may serve as substitute for diminished regional oxygen supply.

Correlation between arterial blood pressures and regional cerebral oxygen saturation in preterm neonates during postnatal transition-an observational study

OBJECTIVE

To assess whether blood pressure (systolic (SABP), diastolic (DABP), and mean arterial blood pressure (MABP) and cerebral-regional-oxygen-saturation (crSO2) and cerebral-fractional-tissue-oxygen-extraction (cFTOE) are associated after immediate fetal-to-neonatal transition in preterm neonates with and without respiratory support.

STUDY DESIGN

Post-hoc analyses of secondary outcome parameters of prospective observational studies were performed. We included moderate and late preterm neonates with and without respiratory support with cerebral NIRS monitoring (INVOS 5100c) and an oscillometric blood pressure measurement at minute 15 after birth. Heart rate (HR) and arterial oxygen saturation (SpO2) were monitored routinely. Blood pressure values were correlated with crSO2 and cFTOE.

RESULTS

47 preterm neonates with NIRS measurements and blood pressure measurement during immediate transition after birth were included. Twenty-five preterm neonates (gestational age: 34.4±1.6 weeks) received respiratory support. In these neonates crSO2 correlated significantly positively with systolic blood pressure (SABP; r = 0.46, p = 0.021), diastolic blood pressure (DABP; r = 0.51, p = 0.009) and, mean arterial pressure (MABP; r = 0.48, p = 0.015). cFTOE correlated significantly negatively with SABP (r = -0.44, p = 0.027), DABP (r = -0.49, p = 0.013) and mean MABP (r = -0.44, p = 0.029). Twenty-two preterm neonates (gestational age: 34.5 ± 1.5 weeks) did not receive respiratory support. In those neonates, neither crSO2 nor cFTOE correlated with blood pressure.

CONCLUSION

In compromised moderate and late preterm neonates with respiratory support, both, crSO2 and cFTOE correlated with blood pressure. These findings suggest that passive pressure-dependent cerebral perfusion was present in preterm neonates with respiratory support, indicating an impaired cerebral autoregulation in those compromised preterm neonates.

Does physiological-based cord clamping improve cerebral tissue oxygenation and perfusion in healthy term neonates? - A randomized controlled trial

OBJECTIVES

To evaluate cerebral tissue oxygenation index (cTOI) during neonatal transition in a group of healthy full-term neonates receiving either a physiological-based approach of deferred cord clamping (CC) after the onset of stable regular breathing (PBCC group) or a standard approach of time-based CC < 1 min (control group). Secondary aim was to evaluate changes in cerebral blood volume (ΔCBV), peripheral arterial oxygen saturation (SpO2) and heart rate (HR) in those neonates.

MATERIALS AND METHODS

We conducted a randomized controlled trial (clinicaltrials.gov: NCT02763436) including vaginally delivered healthy full-term neonates. Continuous measurements of cTOI and ΔCBV using near-infrared spectroscopy, and of SpO2 and HR using pulse oximetry were performed within the first 15 min after birth. Data of each minute of the PBCC group were compared to those of the control group.

RESULTS

A total of 71 full-term neonates (PBCC: n = 35, control: n = 36) with a mean (SD) gestational age of 40.0 (1.0) weeks and a birth weight of 3,479 (424) grams were included. Median (IQR) time of CC was 275 (197-345) seconds and 58 (35-86) seconds in the PBCC and control group, respectively (p < 0.001). There were no significant differences between the two groups regarding cTOI (p = 0.319), ΔCBV (p = 0.814), SpO2 (p = 0.322) and HR (p = 0.878) during the first 15 min after birth.

CONCLUSION

There were no significant differences in the course of cTOI as well as ΔCBV, SpO2 and HR during the first 15 min after birth in a group of healthy full-term neonates, who received either deferred CC after the onset of stable regular breathing or standard CC < 1 min. Thus, deferring CC ≥ 1 min following a physiological-based approach offers no benefits regarding cerebral tissue oxygenation and perfusion after uncomplicated vaginal delivery compared to a time-based CC approach.

Impact of bradycardia and hypoxemia on oxygenation in preterm infants requiring respiratory support at birth

AIM OF THE STUDY

Analysis of the impact of bradycardia and hypoxemia on the course of cerebral and peripheral oxygenation parameters in preterm infants in need for respiratory support during foetal-to-neonatal transition.

METHODS

The first 15 min after birth of 150 preterm neonates in need for respiratory support born at the Division of Neonatology, Graz (Austria) were analyzed. Infants were divided into different groups according to duration of bradycardia exposure (no Bradycardia, brief bradycardia <2 min, and prolonged bradycardia ≥2 min) and to systemic oxygen saturation (SpO₂) value at 5 min of life (<80% or ≥80%). Analysis was performed considering the degree of bradycardia alone (step 1) and in association with the presence of hypoxemia (step 2).

RESULTS

In step 1, courses of SpO₂ differed significantly between bradycardia groups (p = 0.002), while courses of cerebral regional oxygen saturation (crStO₂) and cerebral fractional tissue oxygen extraction (cFTOE) were not influenced (p = 0.382 and p = 0.878). In step 2, the additional presence of hypoxemia had a significant impact on the courses of SpO₂ (p < 0.001), crStO₂ (p < 0.001) and cFTOE (p = 0.045).

CONCLUSION

Our study shows that the degree of bradycardia has a significant impact on the course of SpO₂ only, but when associated with the additional presence of hypoxemia a significant impact on cerebral oxygenation parameters was seen (crStO₂, cFTOE). Furthermore, the additional presence of hypoxemia has a significant impact on FiO₂ delivered. Our study emphasizes the importance of HR and SpO₂ during neonatal resuscitation, underlining the relevance of hypoxemia during the early transitional phase.

Cardiac Output and Cerebral Oxygenation in Term Neonates during Neonatal Transition

The immediate transition from foetus to neonate includes substantial changes, especially concerning the cardiovascular system. Furthermore, the brain is one of the most vulnerable organs to hypoxia during this period. According to current guidelines for postnatal stabilization, the recommended parameters for monitoring are heart rate (HR) and arterial oxygen saturation (SpO₂). Recently, there is a growing interest in advanced monitoring of the cardio-circulatory system and the brain to get further objective information about the neonate’s condition during the immediate postnatal transition after birth. The aim of the present study was to combine cardiac output (CO) and brain oxygenation monitoring in term neonates after caesarean section in order to analyse the potential influence of CO on cerebral oxygenation during neonatal transition. This was a monocentric, prospective, observational study. For non-invasive cardiac output measurements, the electrical velocimetry (EV) method (Aesculon Monitor, Osypka Medical, CA, USA) was used. The pulse oximeter probe for SpO₂ and HR measurements was placed on the right hand or wrist. The cerebral tissue oxygen index (cTOI) was measured using a NIRO-200NX monitor with the near-infrared spectroscopy (NIRS) transducer on the right frontoparietal head. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, mean CO was calculated from six 10 s periods (with beat-to-beat analysis). During the study period, 99 term neonates were enrolled. Data from neonates with uncomplicated transitions were analysed. CO showed a tendency to decrease until minute 10. During the complete observational period, there was no significant correlation between CO and cTOI. The present study was the first to investigate a possible correlation between CO and cerebral oxygenation in term infants during the immediate neonatal transition. In term infants with uncomplicated neonatal transition after caesarean section, CO did not correlate with cerebral oxygenation.

Sex related difference in cardiac output during neonatal transition in term neonates

Background

The immediate transition from foetus to neonate includes substantial changes especially concerning the cardiovascular system. As sex related differences have been shown in cardiovascular medicine, this topic warrants further investigation in neonatology. Aim: The aim of this present study was to measure cardiac output (CO) and cerebral oxygenation (cTOI) non-invasively in term neonates and to investigate potential sex related differences between female and male neonates after birth.

Methods

This is a mono-centric prospective observational study. For CO-measurements, the electrical velocimetry method was used. The pulse oximetry for arterial oxygen saturation and heart-rate measurements was placed on the right hand or wrist. cTOI was measured using a NIRO 200NX monitor. The near-infrared spectroscopy probe was positioned on the right side of forehead in each infant. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, CO was calculated as an average out of six 10-second periods.

Results

99 term neonates were enrolled. In our study population, we could identify 54 female and 45 male neonates. Males had higher cardiac output compared to females throughout the observational period, with a significant difference in minute 15 after birth (217, 95% CI: 203-231 mL/kg/min versus 178, 95% CI: 163-192 mL/kg/min; P<0.001). cTOI, SpO₂, and HR did not differ between male and female neonates.

Conclusions

The present work is the first to investigate sex related differences concerning cardiac output in term neonates during postnatal transition, showing a significantly higher cardiac output in male neonates 15 minutes after birth.

Optimizing noninvasive respiratory support during postnatal stabilization: video-based analysis of airway maneuvers and their effects

OBJECTIVE

Noninvasive respiratory support during postnatal transition may be challenging. Thus, we aimed to analyze frequency and effects of maneuvers to improve noninvasive respiratory support in neonates immediately after birth.

MATERIALS AND METHODS

We included neonates born between September 2009 and January 2015 who were video recorded as part of prospective observational studies and required noninvasive respiratory support during the first 15 min after birth. Maneuvers to improve respiratory support were assessed by video analysis. Vital parameter measurement using pulse oximetry and near-infrared spectroscopy was supplemented by respiratory function monitoring.

RESULTS

One-hundred forty-three of 653 eligible neonates (21.9%) required respiratory support. Video recordings were analyzed in 76 preterm and 58 term neonates, showing airway maneuvers in 105 of them (78.4%). Repositioning of the face mask was the most common maneuver (56.9%). We observed a median of three maneuvers (0-22) in preterm and a median of two maneuvers (0-13) in term neonates (p = .01). Regional cerebral tissue oxygen saturation was significantly higher during the 60 s after the first airway maneuver.

CONCLUSION

Maneuvers to improve respiratory support are commonly required during neonatal resuscitation, with a higher incidence in preterm neonates. The first airway maneuver was associated with an improvement of cerebral tissue oxygenation.

Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO₂/cTOI and prSO₂), arterial oxygen saturation (SpO₂), and heart rate (HR). The secondary outcome parameters of five prospective observational studies are analyzed. We include preterm and term neonates born by Caesarean section who received continuous pulse oximetry and near-infrared spectroscopy monitoring during the first 15 min, and a rectal BT measurement once in minute 15 after birth. Four-hundred seventeen term and 169 preterm neonates are included. The BT did not correlate with crSO₂/cTOI and SpO₂. The BT correlated with the HR in all neonates (ρ = 0.210, p < 0.001) and with prSO₂ only in preterm neonates (ρ = −0.285, p = 0.020). The BT was lower in preterm compared to term infants (36.7 [36.4–37.0] vs. 36.8 [36.6–37.0], p = 0.001) and prevalence of hypothermia was higher in preterm neonates (29.5% vs. 12.0%, p < 0.001). To conclude, the BT did not correlate with SpO₂ and crSO₂/cTOI, however, there was a weak positive correlation between the BT and the HR in the whole cohort and a weak correlation between the BT and prSO₂ only in preterm infants. Preterm neonates had a statistically lower BT and suffered significantly more often from hypothermia during postnatal transition.

Changes in peripheral muscle oxygenation measured with near-infrared spectroscopy in preterm neonates within the first 24 h after birth

BACKGROUND

Near-infrared spectroscopy (NIRS) combined with venous occlusions enables peripheral-muscle oxygenation and perfusion monitoring.

OBJECTIVE

The aim of the present exploratory observational study was to evaluate peripheral-muscle oxygenation and perfusion during the first 24 h after birth in stable preterm neonates.

APPROACH

Secondary outcome parameters of prospective observational studies were analysed. Preterm neonates with peripheral-muscle NIRS measurements combined with venous occlusion on the first day after birth were included. Neonates without circulatory support and without signs of infection/inflammation were included. Neonates were stratified in four groups according to their measurement time-point (6 h-periods) and matched 2:1 for gestational age ±1 week. For each group haemoglobin flow (Hbflow), oxygen-delivery (DO2), oxygen-consumption (VO2), fractional-oxygen-extraction (FOE), tissue-oxygenation-index (TOI) and mixed-venous-oxygenation (SvO2) were calculated. Neonates with measurements during the first 6-hour time period were compared to neonates with measurements of the following time periods.

MAIN RESULTS

40 preterm neonates (gestational age (median(IQR)): 33.5(32.5-34.1)weeks) measured during the first 6 h period after birth were compared to 20 preterm neonates measured in each of the following 6 h periods (period two: 33.7(33.1-34.3)weeks; period three: 34.1(33.2-34.6)weeks; period four: 33.8(32.6-34.6)weeks). Hbflow, DO2 and SvO2 were significantly higher in the second and third 6 h time period compared to the first 6 h period. VO2 did not change significantly during the first day after birth. FOE was significantly lower in the second, third and fourth time period compared to the first 6 h period. TOI showed a non-significant trend towards higher values in the third period compared to the first 6 h period.

SIGNIFICANCE

In preterm neonates Hbflow, DO2, SvO2 increased, FOE decreased and TOI showed a trend towards increase during the first day after birth, whereas VO2 did not change. Changes of peripheral-muscle oxygenation during the first day after birth in stable preterm neonates are different to already published changes thereafter.

Cerebral and peripheral muscle oxygenation and perfusion: Course in moderate and late preterm neonates during the first day after birth

Aim

To investigate the ratio of cerebral tissue oxygenation index (cTOI) to peripheral muscle tissue oxygenation index (pTOI) measured by near-infrared spectroscopy (NIRS) in cardio-circulatory stable preterm neonates without signs of inflammation/infection on the first day after birth.

Methods

Observational study analysing secondary outcome parameters of the 'Avoiding Hypotension in Preterm Neonates (AHIP)' trial (ClinicalTrials.gov identifier: NCT01910467). Preterm neonates, who had cTOI and pTOI measurements during 24 h after birth, were included. In each neonate the mean of the cTOI/pTOI-ratio, cTOI, pTOI and routine monitoring parameters were calculated for each hour and for the 24-h measuring period. Courses of all measured parameters were analysed.

Results

Eighty-seven stable preterm neonates (33.1 [32.1-34.1] weeks of gestation) were included. The mean value over the 24-h measuring period for the cTOI/pTOI-ratio was 0.96 ± 0.02, for cTOI 70.1 ± 1.4 and for pTOI 73.4 ± 0.9. Routine monitoring parameters were in the normal ranges over 24 h. The courses of the cTOI/pTOI-ratio and cTOI showed significantly lower values from hour 5 to 15 compared to the first hours after birth. Heart rate decreased significantly over time, whereas mean arterial blood pressure increased significantly. pTOI, arterial oxygen saturation and body temperature showed no significant change over time.

Conclusion

We are the first to report on cTOI/pTOI-ratios for cardio-circulatory stable preterm neonates over a 24-h period after birth, showing significantly lower values from hour 5 to 15 compared to the first hours after birth.

Fetal Inflammatory Response Syndrome and Cerebral Oxygenation During Immediate Postnatal Transition in Preterm Neonates

Introduction: Fetal inflammatory response syndrome (FIRS), defined as elevated umbilical cord blood interleukin-6 (IL-6) values > 11 pg/ml, is associated with an increased risk of neonatal morbidity and mortality. The primary aim of the present study was to evaluate a potential influence of FIRS on cerebral oxygen saturation (crSO2) and fractional tissue oxygen extraction (cFTOE) during immediate postnatal transition in preterm neonates. The secondary aim was to analyze the potential influence of FIRS on cerebral injury and mortality. Methods: Secondary outcome parameters of prospective observational studies were analyzed. Preterm neonates with measured IL-6 values from umbilical cord blood and cerebral near-infrared spectroscopy (NIRS) measurements during immediate transition after birth were included. Preterm neonates with FIRS (FIRS group) were matched 1:1 for gestational age (± 1 week) to preterm neonates without FIRS (non-FIRS group). crSO2, cFTOE, arterial oxygen saturation (SpO2), heart rate (HR), and fraction of inspired oxygen (FiO2) were compared between both groups. In addition, cerebral injury and mortality were compared between both groups. Results: A total of 46 preterm neonates were included. Twenty-three neonates in the FIRS group [median gestational age 32.1 (IQR 30.3-33.0) weeks; median IL-6 19.7 (IQR 12.2-37.0) pg/ml] were compared to 23 neonates in the non-FIRS group [gestational age: 32.0 (30.4-33.1) weeks; IL-6: 5.4 (3.0-6.7) pg/ml]. cFTOE showed significantly lower values within the first 4 min and a trend toward lower values in minute 5 after birth in the FIRS group. There were no significant differences in crSO2 within the first 15 min after birth between the two groups. SpO2 was significantly lower in minutes 5 and 6 and HR was significantly lower in minutes 2 and 4 after birth in the FIRS group compared to the non-FIRS group. Survival without cerebral injury was similar in both groups. Conclusion: In preterm neonates with FIRS the crSO2 was similar despite significantly lower cFTOE values during the first minutes after birth. This observation may be a result of compromised oxygen consumption and delivery in the first minutes after birth in neonates with FIRS.

Effect of Intrauterine Growth Restriction on Cerebral Regional Oxygen Saturation in Preterm and Term Neonates during Immediate Postnatal Transition

BACKGROUND

Intrauterine growth restriction (IUGR) is associated with adverse perinatal outcome. Affected fetuses commonly display typical blood flow redistribution towards the brain ("brain sparing"). Accordingly, increased cerebral oxygen saturation has been observed in IUGR neonates within the first days of life.

AIM

The aim of our study was to assess cerebral oxygenation behavior during immediate neonatal transition in IUGR infants.

METHODS

This is a retrospective single-center observational cohort study. Cerebral regional oxygen saturation (crSO2) was measured with near-infrared spectroscopy in neonates during the first 15 min after birth. Neonates with IUGR (IUGR group) were matched for gestational age (±1 week) and gender with neonates that were appropriate for gestational age (AGA). The AGA:IUGR matching ratio was 3:1. Arterial oxygen saturation (SpO2), heart rate (HR), crSO2, and cerebral fractional tissue oxygen extraction (cFTOE) were compared between the groups.

RESULTS

Between August 2010 and October 2017, 45 neonates with IUGR were identified and matched to 135 AGA neonates. Mean gestational age was 33.1 ± 3.0 weeks in the IUGR group and 33.5 ± 2.7 weeks in the AGA group. Mean birth weight was 1,559 ± 582 g in the IUGR group and 2,051 ± 679 g in the AGA group. There was a significant group difference in crSO2 beginning at 5 min and continuing for the rest of the observation time with higher crSO2 values in the IUGR group (main effect group: p = 0.011; interaction time × group: p = 0.039). In cFTOE, a significant difference could be observed at 5-9 and 11-13 min with lower rates of oxygen extraction in the IUGR group (main effect group: p = 0.025; interaction time × group: p = 0.463). Concerning SpO2 and HR, there was no significant difference between the IUGR and the AGA neonates.

CONCLUSION

Neonates of the IUGR group did show significantly higher crSO2 values and significantly lower cFTOE values already during immediate neonatal transition compared to the AGA group.

Feasibilty of Transcutaneous pCO2 Monitoring During Immediate Transition After Birth-A Prospective Observational Study

Background: According to recommendations, non-invasive monitoring during neonatal resuscitation after birth includes heart rate (HR) and oxygen saturation (SpO₂). Continuous transcutaneous monitoring of carbon dioxide partial pressure (tcpCO₂) may further offer quantitative information on neonatal respiratory status. Objective: We aimed to investigate feasibility of tcpCO₂ measurements in the delivery room during immediate neonatal transition and to compare the course of tcpCO₂ between stable term and preterm infants. Methods: Neonates without need for cardio-respiratory intervention during immediate transition after birth were enrolled in a prospective observational study. In these term and preterm neonates, we measured HR and SpO₂ by pulse oximetry on the right wrist and tcpCO₂ with the sensor applied on the left hemithorax during the first 15 min after birth. Courses of tcpCO₂ were analyzed in term and preterm neonates and groups were compared. Results: Fifty-three term (gestational age: 38.8 ± 0.9 weeks) and 13 preterm neonates (gestational age: 34.1 ± 1.5 weeks) were included. First tcpCO₂ values were achieved in both groups at minute 4 after birth, which reached a stable plateau after the equilibration phase at minute 9. Mean tcpCO₂ values 15 min after birth were 46.2 (95% CI 34.5-57.8) mmHg in term neonates and 48.5 (95%CI 43.0-54.1) mmHg in preterm neonates. Preterm and term infants did not show significant differences in the tcpCO₂ values at any time point. Conclusion: This study demonstrates that tcpCO₂ measurement is feasible during immediate neonatal transition after birth and that tcpCO₂ values were comparable in stable term and preterm neonates.

Parental Stress Experience and Age of Mothers and Fathers After Preterm Birth and Admission of Their Neonate to Neonatal Intensive Care Unit; A Prospective Observational Pilot Study

Background: Preterm birth is associated with increased stress of parents that might influence the parental-child interaction, thus potentially having influence on the neurobehavioral development of the preterm infants. However, little is known concerning the age dependency of parental stress after preterm birth. Objective: The aim of the present study was to examine the age dependency of stress in mothers and fathers after preterm birth and neonatal intensive care unit (NICU) admission of their infant. Methods: In a prospective observational pilot study 47 mothers and 47 fathers completed the parental stress scale:NICU (PSS:NICU) questionnaire within 72 h after delivery. This questionnaire measures parental stress after preterm birth with three subscales: "Looks and Behave" of the child, "Parental Role Alteration," and "Sights and Sounds." Stress levels of mothers and fathers were compared and correlated to the age of mothers and fathers, respectively. Results: Parental stress experience after preterm birth tended to be higher in mothers compared to fathers. Mothers showed a significant positive correlation of the "Sights and Sounds" scale and age, whereas fathers did not show any significant age dependency of stress. Conclusion: In mothers stress level increases with increasing maternal age after preterm birth and admission of their infant to NICU, whereas fathers did not show any significant age dependency of stress.

Cerebral Oxygenation in Neonates Immediately after Cesarean Section and Mode of Maternal Anesthesia

BACKGROUND

Cerebral regional oxygen saturation (crSO2) during immediate transition and resuscitation immediately after birth is of increasing interest.

OBJECTIVES

The aim of the present study was to assess whether the type of maternal anesthesia during cesarean section (CS; general anesthesia vs. spinal anesthesia) has an influence on cerebral oxygenation during immediate neonatal transition after birth.

METHODS

Secondary outcome parameters of prospective observational studies were analyzed. Neonates born by CS from November 2009 to September 2016 at the Medical University of Graz (Austria) were eligible. Term and preterm neonates were included, provided that: (1) crSO2 was measured by near-infrared spectroscopy, and (2) peripheral arterial oxygen saturation (SpO2) and heart rate (HR) were measured by pulse oximetry during the first 15 min after birth. Administration of supplemental oxygen was recorded and cerebral fractional tissue oxygen extraction (cFTOE) was calculated out of crSO2 and SpO2. For comparison, term and preterm neonates with maternal general anesthesia were matched to neonates with maternal spinal anesthesia during CS.

RESULTS

Out of 760 eligible neonates, 64 term (38.8 ± 0.9 weeks of gestation; 32 neonates in each group) and 54 preterm neonates (32.0 ± 2.9 weeks of gestation; 27 neonates in each group) were included. In term neonates, maternal general anesthesia was associated with lower initial SpO2, HR values, and Apgar scores. The fraction of inspired oxygen (FiO2) was statistically significantly higher in the general anesthesia group. Nevertheless, crSO2 and cFTOE did not differ statistically significantly between the groups. In preterm neonates there were no statistically significant differences in SpO2, HR, crSO2, and cFTOE between the general and spinal anesthesia groups. Apgar scores at 1 min were statistically significantly lower and FiO2 was statistically significantly higher in the general anesthesia group.

CONCLUSION

Cerebral tissue oxygenation in neonates during immediate transition after birth was similar after maternal general and spinal anesthesia during CS, despite differences in SpO2, HR, and supplemental oxygen in term neonates and differences in supplemental oxygen in preterm neonates.

Oxygen Saturation Targeting During Delivery Room Stabilization: What Does This Mean for Regional Cerebral Oxygenation?

Objective: To investigate if preterm neonates with arterial oxygen saturation (SpO₂)<80% at 5 min after birth show different regional cerebral tissue oxygen saturation (rcStO₂), compared to infants reaching the target. Methods: Retrospective analysis of four prospective observational studies. Preterm neonates needing respiratory support during delivery room stabilization were included. Regional cerebral tissue oxygen saturation was measured with near-infrared spectroscopy (NIRS) during the first 15 min after birth along with SpO₂ and heart rate (HR). Neonates were divided into two groups: those with a 5-min SpO₂ ≥ 80% ("≥80% group") and those with a 5-min SpO₂ < 80% ("<80% group"). Groups were compared regarding rcStO₂, SpO₂, and HR. Furthermore, we analyzed whether a 5-min SpO₂ < 80% was associated with a rcStO₂ below the 10th percentile at the same time point. Results: 146 neonates were included, with 68 (47%) in the "≥80% group" and 78 (53%) in the "<80% group." Neonates in the " <80% group" had a significantly lower rcStO₂ (p < 0.001). Furthermore, 80.3% of neonates in the " <80% group" and 23.4% in the "≥80% group" had rcStO₂ values below the 10th percentile at 5 min (p < 0.001). HR was significantly lower at minute 3 and 4 in the " <80% group" (p < 0.002). Conclusion: Preterm infants needing respiratory support, who do not reach the SpO₂ target of 80% at 5 min after birth, show significantly diminished rcStO₂ values compared to neonates reaching the target.

Blood Glucose and Cerebral Tissue Oxygenation Immediately after Birth-An Observational Study

OBJECTIVE

To assess a possible association of blood glucose concentration with cerebral regional oxygen saturation (crSO₂) and cerebral fractional tissue oxygen extraction (cFTOE) in neonates born at term and preterm 15 minutes after birth.

STUDY DESIGN

A post-hoc analysis of secondary outcome measures of 2 prospective observational studies was performed. Neonates born at term and preterm via cesarean delivery were included if cerebral near-infrared spectroscopy measurements were performed during the immediate transition after birth and blood glucose concentrations were measured at 15-20 minutes after birth. Arterial oxygen saturation and heart rate were measured with pulse oximetry. cFTOE was calculated from arterial oxygen saturation and crSO₂ values. crSO₂ and cFTOE 15 minutes after birth were correlated with blood glucose concentrations.

RESULTS

Seventy-five infants were included. In 50 neonates born at term, crSO₂ and cFTOE 15 minutes after birth were 83 ± 7.7% and 0.14 ± 0.08, respectively. In 25 neonates born preterm, crSO₂ and cFTOE 15 minutes after birth were 80.2 ± 12.1%, and 0.15 ± 0.1, respectively. crSO₂ and cFTOE correlated significantly with blood glucose concentrations in neonates born at term and preterm. Increasing blood glucose concentrations were associated with decreasing crSO₂ in neonates born at term (q = -0.35, P = .01) and neonates born preterm (q = -0.69, P = .01) and with increasing cFTOE in neonates born at term (q = 0.31, P = .03) and neonates born preterm (q = 0.67, P = .01).

CONCLUSIONS

Blood glucose concentration was associated with cerebral oxygenation during the immediate transition after birth in neonates born at term and preterm.

Novel algorithm to screen for heart murmurs using computer-aided auscultation in neonates: a prospective single center pilot observational study

BACKGROUND

Automated detection of heart murmurs with computer-aided auscultation is not yet in clinical routine use. Aim of this study was to test sensitivity and specificity of a novel prototype algorithm in automated detection of heart murmurs from digitally recorded phonocardiograms in neonates admitted at the Neonatal Intensive Care Unit.

METHODS

In a prospective pilot observational study from November 2012 to December 2013 auscultations by pediatricians and computer aided auscultation were performed within 12 hours of neonatal echocardiography. Echocardiography was defined as pathological when resulting in any clinical consequences or causing murmur. Phonocardiograms and auscultation were defined as pathological if a murmur was detected. Phonocardiograms were analyzed offline with a novel algorithm prototype (CSD Labs, Graz, Austria) for detection of murmurs in neonates in a first run and with an optimized algorithm in a second run and were compared with echocardiography. Sensitivity and specificity of auscultation by pediatrician and computer aided auscultation were analyzed.

RESULTS

Thirty-six neonates (gestational age: 36±3 weeks) were included. Twenty-three (64%) neonates had pathological or murmur causing findings in echocardiography (positive echocardiography). Sensitivity and specificity of auscultation by pediatrician were 17% and 100%, respectively. In comparison to auscultation by pediatrician sensitivity of first run and second run were significantly higher with 70% and 83%, respectively. Specificity of first run and second run were 77% and 85%, respectively.

CONCLUSIONS

Phonocardiogram analysis using the novel algorithm prototype had a higher sensitivity than auscultation by pediatrician in detecting positive echocardiography findings in neonates.

Tactile stimulation during neonatal transition and its effect on vital parameters in neonates during neonatal transition

AIM

This study analysed tactile stimulation during neonatal transition and resuscitation in preterm and term neonates born by Caesarean delivery. It examined the frequency, location and body region, duration and possible effects of stimulation on heart rate and arterial oxygen saturation (SpO₂ ).

METHODS

Two independent investigators analysed video recordings of tactile stimulation on term and preterm neonates during neonatal transition from January 2012 to December 2014. They were recorded during a prospective observational study and randomised controlled trial at a tertiary centre, the Medical University of Graz, Austria. SpO₂ and heart rate were continuously recorded. Data on the frequency, body region and duration of stimulation were collected. To investigate the possible effects of stimulation, SpO₂ and heart rate were compared before and after stimulation.

RESULTS

Term infants received tactile stimulation more than once, and it tended to start later, last longer and be applied in more locations than in preterm infants. Only preterm infants showed a significant increase in SpO₂ after stimulation and heart rates did not show any significant changes in either group.

CONCLUSION

Tactile stimulation was applied in different ways to preterm and term infants during neonatal transition and SpO₂ showed a significant increase in preterm infants.

Avoiding Arterial Hypotension in Preterm Neonates (AHIP)-A Single Center Randomised Controlled Study Investigating Simultaneous Near Infrared Spectroscopy Measurements of Cerebral and Peripheral Regional Tissue Oxygenation and Dedicated Interventions

INTRODUCTION

Up to 50% of preterm infants admitted to intensive care units require cardiocirculatory support. The aim of the present study was to assess whether simultaneous monitoring of cerebral tissue oxygenation index (cTOI) and peripheral tissue oxygenation index (pTOI) using near-infrared spectroscopy (NIRS) in combination with dedicated intervention guidelines may help avoiding arterial hypotension and catecholamine administration in preterm neonates.

STUDY DESIGN

Preterm neonates <37 weeks of gestation were included in a single center randomized controlled study. Blood pressure was measured non-invasively or invasively. In the NIRS group, simultaneous cTOI and pTOI monitoring was used starting within 6 h after birth for 24 h to calculate changes in cTOI/pTOI ratio over time. Depending on these changes, interventions including echocardiography, administration of volume or patent ductus arteriosus treatment were performed. In the control group, only routine monitoring and treatment were performed and NIRS signals were not visible. The primary outcome was burden of hypotension within 48 h after initiation of NIRS monitoring.

RESULTS

49 preterm neonates were included in each group: NIRS group 33.1 (32.0-34.0) (median: 25-75 centile) weeks of gestation and control group 33.4 (32.3-34.3) weeks of gestation. In the NIRS group, echocardiography was performed in 17 preterm neonates due to NIRS measurements, whereby six neonates received further treatment. Percentage of neonates with any hypotensive episode during the 48-h observational period was 32.6% in the NIRS group and 44.9% in the control group (p = 0.214). Burden of hypotension (i.e., %mmHg of mean arterial pressure < gestational age) was 0.0 (0.0-2.1) mmHg h in the NIRS group and 0.4 (0.0-3.3) mmHg h in the control group (p = 0.313), with observed burden of hypotension being low in both groups. No severe adverse reactions were observed.

CONCLUSION

In preterm neonates using simultaneous peripheral and cerebral NIRS measurements for early detection of centralization followed by predefined interventions led to a non-significant reduction in burden of arterial hypotension.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT01910467.

Cerebral Blood Volume During Neonatal Transition in Term and Preterm Infants With and Without Respiratory Support

Background: Recently, we demonstrated that in healthy newborn infants cerebral blood volume (CBV) was decreasing continuously after birth. We hypothesized that this was due to the increase in oxygen delivery to the brain during neonatal transition. Thus delayed cerebral oxygen delivery in infants in need for respiratory support (RS) during postnatal stabilization might influence changes in CBV. Objective: Aim of the study was to evaluate transitional changes in CBV immediately after birth in term and preterm infants with and without need of RS. Methods: We performed a post-hoc analysis of data collected as primary and secondary outcome parameters in prospective observational studies and randomized controlled trials at the Medical University of Graz (Austria). NIRS measurements by using "NIRO 200-NX" (Hamamatsu, Japan) were carried out over the first 15 min after birth in term and preterm infants delivered by cesarean section with and without requirement for RS. Results: In 204 neonates, we observed a significant decrease in CBV within the first 15 min after birth (p < 0.001) with a trend toward smaller ΔCBV in neonates receiving RS (p = 0.097) compared to neonates without RS. Differences of ΔCBV between groups reached statistically significance (p < 0.05) at minutes 2, 6, and 7, and showed a trend (p < 0.1) at minutes 3, 4, and 5. After adjusting for gestational age, these differences became smaller and failed to reach significance. Conclusions: We observed a significant decrease of CBV in term and preterm infants with and without RS. Interestingly, ΔCBV was smaller in the first 7 min in neonates with RS reaching statistically significance (p < 0.05) at minutes 2, 6, and 7. This study cannot differentiate, whether RS itself or the condition leading to requirement for RS is responsible for the observed CBV behavior.

Antenatal Consultation and Postnatal Stress in Mothers of Preterm Neonates (A Two-Center Observational Case-Control Study)

BACKGROUND

During antenatal consultation of women hospitalized for preterm labor, information of possible adverse outcomes is provided. This may however create additional maternal stress and raise some ethical concerns.

OBJECTIVE

The aim of the present study was to evaluate the influence of antenatal consultation by a neonatologist on maternal stress after delivery of a preterm infant admitted to NICU.

METHODS

In this study, secondary outcome parameters of a prospective two-center pilot observational study were analyzed. Mothers of preterm neonates < 36 weeks of gestation admitted at two tertiary-level Neonatal-Intensive-Care-Units (NICU) were included. Maternal stress was assessed with the Parental-Stress-Scale:NICU (PSS:NICU) within 72 h after birth. PSS:NICU measures three scales: "relationship and parental role," "sights and sounds," and "baby looks and behaves." Maternal sociodemographic data were collected by questionnaire administered at the same time. Mothers who received antenatal neonatal consultation were matched for gestational age and compared to mothers who had no antenatal consultation by a neonatologist.

RESULTS

A total of 46 mothers of preterm neonates were included, 23 mothers in each group. There was no significant difference in sociodemographic data between the two groups regarding neonates and mothers. There were no significant differences between the two groups regarding stress scales of "sights and sounds" (2.00 ± 0.76 versus 2.19 ± 0.79; p = 0.402), "looks and behaves" (2.55 ± 0.90 versus 2.48 ± 0.94; p = 0.732) and "relationship and parental role" (3.28 ± 1.23 versus 3.46 ± 1.07; p = 0.517).

CONCLUSION

Our study demonstrated that antenatal consultation by a neonatologist had no substantial influence on postnatal maternal stress in mothers of preterm neonates admitted to the NICU.

Peripheral Intravenous Access in Preterm Neonates during Postnatal Stabilization: Feasibility and Safety

BACKGROUND

Current European Guideline for resuscitation recommends a centrally positioned umbilical venous catheter as the best option for administering necessary drugs. Especially in preterm infants, a frequently used alternative is the peripheral venous catheter.

METHODS

Two randomized controlled studies were conducted at the Division of Neonatology, Medical University of Graz. During neonatal resuscitation, a standardized protocol was filled out by an uninvolved observer including time points after birth of all attempts of venous puncture, time point of successful venous puncture, and total number of needed attempts. Arterial oxygen saturation (SpO₂) and heart rate (HR) were measured using pulse oximetry at the right hand/wrist. In each neonate, either NIRO 200NX (Hamamatsu, Japan) or INVOS 5100C (Covidien-Medtronic, USA) were used to measure cerebral tissue oxygenation index (cTOI) and cerebral regional oxygen saturation (crSO₂), respectively. SpO₂, HR, and cTOI/crSO₂ during and 1 min before and after successful venous punctures were analyzed.

RESULTS

70 protocols were reviewed. Data of 61 preterm neonates were analyzed. Mean gestational age was 31.5 ± 2.2 weeks, and the mean birth weight was 1,527 ± 541 g. In median, it needed one attempt [interquartile range (IQR) 1-2] to establish a peripheral venous catheter. In median, intravenous (IV) catheterization was successfully established 5 (IQR 4-9) min after birth. SpO₂ and cTOI/crSO₂ rose significantly following the percentiles during the first 10 min after the birth. HR did not change significantly.

CONCLUSION

Peripheral IV catheterization during postnatal stabilization of preterm infants is feasible and successful in most of the cases at first attempt.