Valerie Y Chock1, Soo Hyun Kwon2, Namasivayam Ambalavanan3, Beau Batton4, Leif D Nelin5, Lina F Chalak6, Lu Tian1, Krisa P Van Meurs1. 1. Division of Neonatology, Stanford University School of Medicine, Stanford, CA. 2. Division of Neonatology, Yale School of Medicine, New Haven, CT. 3. Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL. 4. Division of Neonatology, Southern Illinois University School of Medicine, Springfield, IL. 5. Division of Neonatology, Nationwide Children's Hospital, Ohio State University, Columbus, OH. 6. Division of Neonatology, University of Texas Southwestern, Dallas, TX.
Abstract
OBJECTIVE: To determine if decreased cerebral oxygenation or altered cerebral autoregulation as measured by near-infrared spectroscopy (NIRS) in the first 96 postnatal hours is associated with an increased risk of death or severe neuroradiographic abnormalities in very preterm infants. STUDY DESIGN: The Early NIRS prospective, multicenter study enrolled very preterm infants with a birth weight of <1250 g from 6 tertiary neonatal intensive care units. Mean arterial blood pressure and cerebral oxygen saturation (Csat) were continuously monitored using a neonatal sensor until 96 hours of age. Moving window correlations between Csat and mean arterial blood pressure determined time periods with altered cerebral autoregulation, and percentiles of correlation were compared between infants with and without the adverse outcome of mortality or severe neuroradiographic abnormalities by early cranial ultrasound. RESULTS: Of 103 subjects with mean gestational age of 26 weeks, 21 (20%) died or had severe neuroradiographic abnormalities. Infants with adverse outcomes had a lower mean Csat (67 ± 9%) compared with those without adverse outcomes (72 ± 7%; P = .02). A Csat of <50% was identified as a cut-point for identifying infants with adverse outcome (area under the curve, 0.76). Infants with adverse outcomes were more likely to have significant positive or negative correlations between Csat and mean arterial blood pressure, indicating impaired cerebral autoregulation (P = .006). CONCLUSIONS: Early NIRS monitoring may detect periods of lower cerebral oxygenation and altered cerebral autoregulation, identifying preterm infants at risk for mortality or neuroradiographic injury. An improved understanding of the relationship between altered hemodynamics and cerebral oxygenation may inform future strategies to prevent brain injury.
OBJECTIVE: To determine if decreased cerebral oxygenation or altered cerebral autoregulation as measured by near-infrared spectroscopy (NIRS) in the first 96 postnatal hours is associated with an increased risk of death or severe neuroradiographic abnormalities in very preterm infants. STUDY DESIGN: The Early NIRS prospective, multicenter study enrolled very preterm infants with a birth weight of <1250 g from 6 tertiary neonatal intensive care units. Mean arterial blood pressure and cerebral oxygen saturation (Csat) were continuously monitored using a neonatal sensor until 96 hours of age. Moving window correlations between Csat and mean arterial blood pressure determined time periods with altered cerebral autoregulation, and percentiles of correlation were compared between infants with and without the adverse outcome of mortality or severe neuroradiographic abnormalities by early cranial ultrasound. RESULTS: Of 103 subjects with mean gestational age of 26 weeks, 21 (20%) died or had severe neuroradiographic abnormalities. Infants with adverse outcomes had a lower mean Csat (67 ± 9%) compared with those without adverse outcomes (72 ± 7%; P = .02). A Csat of <50% was identified as a cut-point for identifying infants with adverse outcome (area under the curve, 0.76). Infants with adverse outcomes were more likely to have significant positive or negative correlations between Csat and mean arterial blood pressure, indicating impaired cerebral autoregulation (P = .006). CONCLUSIONS: Early NIRS monitoring may detect periods of lower cerebral oxygenation and altered cerebral autoregulation, identifying preterm infants at risk for mortality or neuroradiographic injury. An improved understanding of the relationship between altered hemodynamics and cerebral oxygenation may inform future strategies to prevent brain injury.
Authors: Valerie Y Chock; Emily Smith; Sylvia Tan; M Bethany Ball; Abhik Das; Susan R Hintz; Haresh Kirpalani; Edward F Bell; Lina F Chalak; Waldemar A Carlo; C Michael Cotten; John A Widness; Kathleen A Kennedy; Robin K Ohls; Ruth B Seabrook; Ravi M Patel; Abbot R Laptook; Toni Mancini; Gregory M Sokol; Michele C Walsh; Bradley A Yoder; Brenda B Poindexter; Sanjay Chawla; Carl T D'Angio; Rosemary D Higgins; Krisa P Van Meurs Journal: Pediatr Res Date: 2022-05-05 Impact factor: 3.953
Authors: Ena Suppan; Gerhard Pichler; Corinna Binder-Heschl; Bernhard Schwaberger; Berndt Urlesberger Journal: Front Pediatr Date: 2022-06-13 Impact factor: 3.569