Nariae Baik

Cerebral haemorrhage in preterm neonates: does cerebral regional oxygen saturation during the immediate transition matter?

Objectives To investigate the occurrence of peri/intraventricular haemorrhage (P/IVH) in preterm infants and its potential association with cerebral regional oxygen saturation (crSO2) during the immediate transition. Methods In this two-centre prospective observational cohort study, crSO2 was measured with near-infrared spectroscopy in preterm infants (<32 weeks of gestational age) during the immediate neonatal transition (15 min). In addition, arterial oxygen saturation (SpO2) and heart rate (HR) were monitored with pulse oximetry. Cranial ultrasound scans were performed on day 4, day 7 and day 14 after birth and before discharge. Neonates with IVH of any grade (IVH group) were matched to the neonates without IVH (Non-IVH group) on gestational age (±1 week) and birth weight (±100 g). The duration and magnitude of deviation from the 10th centile in crSO2 during immediate transition was analysed and expressed in %minutes. Results IVH was found in 12 of the included neonates, who were matched to 12 neonates without IVH. There was no difference in SpO2 and HR between these two groups. The duration and magnitude of centiles-deviation of crSO2 was significantly pronounced in the IVH group compared with the Non-IVH group (1870%min vs 456%min). Conclusions The neonates of the IVH group showed significantly lower crSO2 values during the immediate transition, although there was no difference concerning SpO2 and HR. The additional monitoring of crSO2 during the immediate transition could reveal neonates with higher risk of developing an IVH later in the course.

Reference Ranges for Cerebral Tissue Oxygen Saturation Index in Term Neonates during Immediate Neonatal Transition after Birth.

Background: Non-invasive monitoring of the brain with near-infrared spectroscopy (NIRS) during immediate transition after birth is of growing interest. Objective: The aim of this work was to define reference ranges and centile charts for a regional cerebral tissue oxygenation index (cTOI), measured with the NIRO 200NX (NIRO, Hamamatsu, Japan), and cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 min after birth in preterm and term neonates without any medical support. Methods: cTOI was measured with the NIRO 200NX during the first 15 min after delivery via Caesarean section in preterm and term infants. The NIRS-sensor was placed on the right forehead. Peripheral arterial oxygen saturation (SpO2) and heart rate were continuously measured by pulse oximetry. cFTOE was calculated out of cTOI and SpO2. Neonates with a requirement for any medical support were excluded. Results: A total of 230 neonates were enrolled, from which 90 had to be excluded. Therefore, 140 term neonates were included and data were used to define reference ranges and centile charts. The 50th centile (10th to 90th centiles) of cTOI was 56% (39-75) at 2 min, 66% (50-78) at 5 min, 75% (62-85) at 10 min and 73% (61-84) at 15 min after birth. The 50th centile of cFTOE was 0.24 (0.11-0.44) at 2 min, 0.20 (0.10-0.35) at 5 min, 0.21 (0.09-0.35) at 10 min and 0.24 (0.13-0.37) at 15 min after birth. Conclusion: The present observational study adds the reference ranges and centile charts of cTOI measured with the NIRO 200NX and cFTOE calculated out of cTOI and SpO2 in neonates during the immediate neonatal transition. Centiles for each instrument will be necessary for future clinical application, since the differences between cTOI and cerebral regional tissue oxygen saturation measured with INVOS 5100C change with increasing regional oxygenation.

Do Sustained Lung Inflations during Neonatal Resuscitation Affect Cerebral Blood Volume in Preterm Infants? A Randomized Controlled Pilot Study.

Background Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn’t been investigated yet. Objective Do SLI affect cerebral blood volume (CBV) in preterm infants? Methods Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial. Within the first 15 minutes after birth near-infrared spectroscopy (NIRS) measurements using ‘NIRO-200-NX’ (Hamamatsu, Japan) were performed to evaluate changes in CBV and cerebral tissue oxygenation. Two groups were compared based on RS: In SLI group RS was given by applying 1–3 SLI (30 cmH2O for 15 s) continued by respiratory standard care. Control group received respiratory standard care only. Results 40 infants (20 in each group) with mean gestational age of 32 weeks one day (±2 days) and birth weight of 1707 (±470) g were included. In the control group ΔCBV was significantly decreasing, whereas in SLI group ΔCBV showed similar values during the whole period of 15 minutes. Comparing both groups within the first 15 minutes ΔCBV showed a tendency toward different overall courses (p = 0.051). Conclusion This is the first study demonstrating an impact of SLI on CBV. Further studies are warranted including reconfirmation of the present findings in infants with lower gestational age. Future investigations on SLI should not only focus on respiratory outcome but also on the consequences on the developing brain. Trial Registration German Clinical Trials Register DRKS00005161 https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do

Cardiocirculatory monitoring during immediate fetal-to-neonatal transition: a systematic qualitative review of the literature.

Background: The fetal-to-neonatal transition is a complex process that includes changes in cardiac and respiratory systems. Objective: The aim of this study is to review the different methods of cardiocirculatory monitoring during the immediate neonatal transition period. Methods: A systematic search of PubMed and Ovid Embase was performed using the following terms: infant, newborn, newborn infant, neonate, neonates, heart, cardiac, blood pressure, haemodynamic, hemodynamics, blood circulation, circulation, echocardiography, ultrasonography, sonography, electrocardiography, ECG, oximetry, pulse, pulse oximetry, monitoring, measurement, acclimatization, adaptation, transition, after birth and delivery room. Additional articles were identified by manual search of cited references. Only human studies describing cardiocirculatory monitoring during the first 15 min after birth were included. Results: Thirteen studies were identified that described heart rate (HR). Additional five studies were identified that measured blood pressure. Four studies performed functional echocardiography during neonatal transition; two in addition to blood pressure monitoring and three in addition to HR monitoring. Conclusion: Routine HR monitoring using electrocardiography or pulse oximetry is used to evaluate adequate hemodynamic transition, and reference ranges have been established. Measuring blood pressure noninvasively though noncontinuously might be of some value in future, considering that the normative data have been established recently. Echocardiographic monitoring during the immediate transition period will improve the knowledge about cardiac function changes, but introduction in clinical routine remains questionable.

Near-infrared spectroscopy for objectifying cerebral effects of laser acupuncture in term and preterm neonates.

Laser acupuncture (LA) becomes more and more relevant in neonates and infants. With near-infrared spectroscopy (NIRS), a continuous and noninvasive measurement of tissue oxygenation is possible. Aim was to investigate, whether the application of LA was associated with any changes in regional cerebral oxygen saturation (rcSO2) in term and preterm neonates. The study included 20 neonates (12 males, 8 females). The Large Intestine 4 acupuncture point (LI 4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm laser needle EG GmbH, Germany) for 5 minutes, bilaterally. All neonates underwent polygraphic recording during undisturbed daytime sleep, including heart rate (HR), peripheral oxygen saturation (SpO2), and measurement of nasal flow. Using NIRS, rcSO2 was measured continuously. Cerebral fractional tissue oxygen extraction (cFTOE) was calculated. We did not observe any significant changes in SpO2 and HR values during the whole observation period. However, there was a significant decrease in rcSO2 (P = 0.003) within postintervention period, accompanied by a significant increase in cFTOE (P = 0.010) in postintervention period.

Cord clamping time in spontaneously breathing preterm neonates in the first minutes after birth: impact on cerebral oxygenation – a prospective observational study

Abstract Objective: To analyse impact of delayed cord clamping (DCC60sec) on cerebral regional tissue oxygenation (crSO2) and fractional tissue oxygen extraction (cFTOE) in spontaneously breathing preterm neonates during the first 15 min after birth. Methods: Two-centre observational study, crSO2 and cFTOE was monitored in neonates with DCC60sec or early cord clamping (ECC < 30 s). Results: Seventy-six infants (birth weight and gestational age 1736 ± 508 g and 31.8 ± 2.5 weeks) were included. DCC was associated with lower initial crSO2 and higher cFTOE and lower initial Apgar-score and heart rate. Conclusion: Attending practitioners should be aware that DCC might impact initial immediate transition in spontaneously breathing preterm neonates.

Haemodynamic Transition after Birth: A New Tool for Non-Invasive Cardiac Output Monitoring

Background: Substantial haemodynamic changes occur during the first minutes after birth. Currently, only heart rate (HR) and arterial oxygen saturation are routinely used to monitor haemodynamic transition after birth. Objectives: The aim of the present study was to continuously assess haemodynamic changes during transition in term infants for the first time by using electrical velocimetry (EV), a new method of non-invasive cardiac output monitoring (NICOM), based on impedance cardiography technology. Methods: In this prospective observational study, term neonates delivered by elective caesarean section underwent NICOM measurements within the first 15 min after birth. The beat-to-beat measurement over a 10-second period was used to calculate cardiac output (CO) for each minute after birth. The data of CO were only accepted when the signal quality index (SQI) remained >80% during the measurement period of 10 s. Results: 100 term neonates underwent 1,500 NICOM measurements. 1,143 (76.2%) measurements were excluded because of a SQI <80%. HR and CO showed a trend to increase within the first minutes, and decreased significantly from minute 3 (HR) and 4 (CO), until minute 12 and 10, respectively. Stroke volume remained stable during the observation period. Conclusion: The present study was the first using EV for NICOM during the transition period in a larger cohort of newborn infants. Results of NICOM were similar to available echocardiography data. The possibility of NICOM offers continuous CO measurement. The present study supports the idea that CO is closely related to HR in newborn infants.

Peripheral Muscle Near-Infrared Spectroscopy in Neonates: Ready for Clinical Use? A Systematic Qualitative Review of the Literature

Background: Peripheral muscle near-infrared spectroscopy (NIRS) measurements are of increasing interest especially in the care of critically ill patients. Objective: The aim was to perform a systematic qualitative review on peripheral muscle NIRS measurements in the clinical care of term and preterm neonates. Methods: A systematic search of PubMed and Ovid Embase was performed using the following terms: neonate, neonates, newborn, newborns, infant, infants, near-infrared spectroscopy, NIRS, oxygenation, perfusion, oxygen extraction, peripheral, tissue, muscle, calf, forearm and thigh. Additional articles were identified by a manual search of the cited references. Only human studies were included. Results: Twenty-one studies were identified to use peripheral muscle NIRS measurements as a single method, 17 studies combined cerebral and peripheral muscle NIRS measurements and 1 study used multi-site NIRS measurements in human neonates. Two randomized studies were identified. Two additional publications were included because they provided important general information about peripheral muscle NIRS measurements. Conclusion: In the care of critically ill neonates peripheral muscle NIRS measurements alone or in combination with cerebral or multi-site NIRS measurements provide useful additional information about peripheral circulation and oxygenation. This method is a promising tool in the recognition of early states of centralization (compensated shock) in this vulnerable group of patients. However, before this method can be used in the clinical routine it has to be tested as monitoring to guide interventions in further studies.

Blood Pressure during the Immediate Neonatal Transition: Is the Mean Arterial Blood Pressure Relevant for the Cerebral Regional Oxygenation?

Background: Measurement of mean arterial blood pressure (MABP) is feasible during neonatal transition. Objective: The objective of this study was to investigate a potential influence of MABP on the cerebral regional oxygen saturation (crSO2) in preterm and term infants during the immediate neonatal transition. Materials and Methods: Preterm and term infants were included in this observational study. The crSO2 was measured by near-infrared spectroscopy with the INVOS 5100C (Somanetics Corp., Troy, MI, USA) during the immediate neonatal transition (15 min after birth). The near-infrared spectroscopy sensor was applied to the left forehead. Furthermore, a pulse oximeter was applied to monitor arterial oxygen saturation (SpO2) and heart rate (HR). Fifteen minutes after birth, blood pressure was measured noninvasively at the left upper arm. Cerebral fraction tissue oxygen extraction (cFTOE) was calculated from SpO2 and crSO2. To investigate a potential association between crSO2/cFTOE and MABP, we performed a correlation analysis. Results: A total of 462 preterm and term infants (186/292) were included. Mean gestational age was 31.0 ± 3.5 weeks for preterm infants and 38.9 ± 0.8 weeks for full term infants. Mean birth weight was 1.591 ± 630 g in preterm infants and 3.331 ± 461 g in term infants. There was a significant negative correlation between MABP and cFTOE (ρ = -0.19, p = 0.03) in preterm infants but not in term infants (ρ = 0.05, p = 0.39). There was no significant correlation between MABP and crSO2 in either group. Conclusion: MABP has an impact on cerebral oxygenation in preterm infants. Therefore, blood pressure monitoring during the immediate neonatal transition might be relevant for improving cerebral oxygenation especially in preterm infants.

Cerebral hypoxia during immediate transition after birth and short term neurological outcome

In preterm neonates we investigated cerebral hypoxia assessed with near-infrared-spectroscopy during immediate transition after birth and general movement optimality score assessed before discharge. General movement optimality score decreased with increasing cerebral hypoxia. Burden of cerebral hypoxia during immediate transition might be associated with impaired short-term neurological outcome in preterm neonates.