Cerebral oxygenation and haemodynamics in the foetus and newborn infant.

Quantitative techniques have been derived for the measurement of global cerebral blood flow, cerebral blood volume, its response to changing arterial carbon dioxide tension and mixed cerebral venous saturation in the human newborn undergoing intensive care. Normal ranges have been established and significant disturbances of cerebral oxygenation and perfusion have been demonstrated in a variety of pathological conditions. Recently, absolute cerebral deoxyhaemoglobin concentration has been obtained in the newborn using second differential spectroscopy. When combined with the measurement of total cerebral haemoglobin concentration, the mean saturation of cerebral blood (SmcO2) may be obtained, allowing global cerebral oxygenation to be determined continuously in the intensive care unit. Marked changes in the concentrations of cerebral oxy- and deoxyhaemoglobin have been observed in foetuses undergoing labour. Measurements of SmcO2 from the foetal brain prior to delivery have shown the expected close correlation with acid-base status at birth. Although movement artefact remains a theoretical risk during uterine contractions, preliminary measurements of optical path length by intensity-modulated spectroscopy have demonstrated only small fluctuations. In future the clinical application of time, phase and spatially resolved spectroscopy is likely to improve both the quantitative accuracy and the regional specificity of physiological measurements in the foetal and neonatal brain.