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

Abstract

IntroductionUp 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 designPreterm 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.Results49 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.ConclusionIn 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, identifier: NCT01910467.

Simultaneous Near-Infrared Spectroscopy (NIRS) and Amplitude-Integrated Electroencephalography (aEEG): Dual Use of Brain Monitoring Techniques Improves Our Understanding of Physiology

“…The early impact on somatic tissue oxygenation has also been documented in neonates with congenital heart disease (19) and in children with dehydration requiring volume resuscitation (20) due to redistribution of blood flow with hemodynamic compromise. NIRS monitoring to guide management of hypotension in preterm infants (21) found a reduction in the burden of hypotension. In contrast, there has been limited use of aEEG in patients with hemodynamic instability.…”

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

“…The nurses in charge of the patients checked the sensors on the abdominal and cerebral sites every 4 hours to assess for skin irritation and the need to reposition the sensor. 16 They also verified that the numerical values for each measurement site were on the screen.…”

Measurement of gut oxygenation in the neonatal population using near-infrared spectroscopy: a clinical tool?

“…Concurrently, many of the studies did not use NIRS as a tool to help predict the onset of pathology which would be of interest in its potential clinical applications and hence requires further study. Pichler et al 50 have recently published the first single-centre randomised controlled trial using cerebral NIRS to decide the management for arterial hypotension and comparing this to a control group. This shows great promise toward NIRS becoming a more regularly used non-invasive tool to assess neonatal haemodynamics.…”