Bradycardias are associated with more severe effects on cerebral oxygenation in very preterm infants than in late preterm infants

Walter, Lisa M.; Ahmed, Badreldeen; Odoi, Alexsandria; Cooney, Hannah; Horne, Rosemary Sylvia Claire; Wong, Flora Yuen-Wait

doi:10.1016/j.earlhumdev.2018.08.008

Cited by 14 publications

(8 citation statements)

References 36 publications

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“…In turn, these are significantly influenced not only by the event type, but also by specific neonatal characteristics, such as abnormal umbilical Doppler or the presence of a hsPDA. CRE characterized by a combined drop in SpO 2 and HR had the highest impact on cerebral oxygenation; this is consistent with previous findings describing a significant reduction of this parameter during DB compared to isolated events (Schmid et al 2015b;Walter et al 2018).…”

Section: Discussionsupporting

confidence: 92%

“…The unfavourable effects of CRE on cerebral haemodynamics in the preterm population have also been established (Schmid 2015a;Garvey et al 2018). A transient decrease in cerebral oxygenation has been documented during both bradycardic and hypoxic episodes, which can be deeper if the two events occur simultaneously (Schmid et al 2015b;Walter et al 2018). Fluctuations between cerebral hypoxia and hyperoxia activate a pro-oxidant cascade that triggers an inflammatory response and alters the balance of neurotransmitters (Di Fiore et al 2019).…”

Section: Introductionmentioning

confidence: 99%

“…2015 b ; Walter et al . 2018). Fluctuations between cerebral hypoxia and hyperoxia activate a pro‐oxidant cascade that triggers an inflammatory response and alters the balance of neurotransmitters (Di Fiore et al .…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular and cerebrovascular responses to cardio‐respiratory events in preterm infants during the transitional period

Martini

Frabboni

Rucci

et al. 2020

The Journal of Physiology

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Key points Non‐invasive simultaneous multiparametric monitoring allows the in vivo evaluation of cerebral and cardiovascular haemodynamic responses to different types of recurrent episodes of intermittent hypoxia and/or bradycardia, also defined as cardio‐respiratory events (CRE), in preterm neonates during postnatal transition. By decreasing left cardiac output, bradycardia further contributes to cerebral hypoxia during CRE. The presence of a haemodynamically significant patent ductus arteriosus results in a deeper impairment of cerebral oxygen status in response to CRE, whereas the brain‐sparing remodelling of the fetal circulation resulting from placental insufficiency is associated with more favourable haemodynamic responses to intermittent hypoxia. During transition, the haemodynamic impact of CRE is influenced not only by the event type, but also by specific clinical features; this highlights the importance of developing individualized approaches to reduce the hypoxic burden in this delicate phase. Abstract The present observational prospective study aimed to investigate cerebral and cardiovascular haemodynamic responses to different types of cardio‐respiratory events (CRE) in preterm infants during postnatal transition, as well as evaluate the impact of relevant clinical characteristics. Infants with gestational age (GA) <32 weeks and/or birth weight <1500 g were enrolled after birth. Cerebral oxygenation index (cTOI), fractional oxygen extraction (cFTOE), cardiac output (CO), cardiac contractility (iCON) and systemic vascular resistances (sVR) were simultaneously monitored over the first 72 h by near‐infrared spectroscopy and electrical velocimetry. CRE were clustered into isolated bradycardia (IB), isolated desaturation (ID) and combined desaturation/bradycardia (DB). For each parameter, percentage changes from baseline (%Δ) were calculated. The impact of different CRE types and clinical variables on %Δ was evaluated with generalized estimating equations. In total, 1426 events were analysed. %ΔcTOI significantly differed among ID, IB and DB (P < 0.001), with the latter showing the greatest drop. %ΔcFTOE decreased significantly during DB (P < 0.001) and ID (P < 0.001) compared to IB. DB and IB were associated with more negative %ΔCO (P < 0.001) and more positive %ΔsVR (P < 0.001) compared to ID. A slight iCON reduction was observed during DB compared to ID (P = 0.043). Antenatal umbilical Doppler impairment, GA and the presence of a haemodynamically significant patent ductus arteriosus had a significant independent impact on %ΔcTOI, %ΔcFTOE and %ΔCO. During the transitional period, the haemodynamic responses to CRE are influenced by the event type and by specific neonatal characteristics, suggesting the importance of targeted individualized approaches for minimizing the risk of cerebral injury in the preterm population.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular and cerebrovascular responses to cardio‐respiratory events in preterm infants during the transitional period

Martini

Frabboni

Rucci

et al. 2020

The Journal of Physiology

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“…This can represent an important element of monitoring for preterm neonates. In addition to tcSatO 2 , the crSaO 2 and FTOE values allow for direct information on brain oxygenation process during the apnoea and, subsequently, a prompt therapeutic intervention [ 13 , 14 , 15 , 16 , 17 ]. It is important to maintain these parameters in normal range in preterm neonates because low oxygenation is associated with a poor neurodevelopmental outcome [ 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Association Analysis of the Cerebral Fractional Tissue Oxygen Extraction (cFTOE) and the Cerebral Oxygen Saturation (crSaO2) with Perinatal Factors in Preterm Neonates: A Single Centre Study

Matyas

Iancu

Hășmășanu

et al. 2022

JCM

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(1) Background: Near-infrared spectroscopy (NIRS) is a non-invasive, easily performed method of monitoring brain oxygenation. The regional cerebral oxygen saturation (crSaO2) and the cerebral fractional tissue oxygen extraction (cFTOE) evaluated by NIRS provide more accurate information on brain oxygenation than the blood oxygen saturation. We investigated the effect of perinatal factors on cerebral oxygenation of preterm newborns. (2) Methods: We conducted a longitudinal study with 48 preterm newborns <34 weeks of gestation who underwent NIRS registration during the first 72 h of life. crSaO2 was measured and cFTOE was calculated foreach patient. (3) Results: One-way ANOVA showed no significant main effect of IVH severity on crSaO2 and cFTOE (p > 0.05); there was a tendency toward statistical significance concerning the difference between the means of crSaO2 (p = 0.083) and cFTOE (p = 0.098). Patients with intraventricular haemorrhage (IVH) had a lower mean of crSaO2 and a higher mean of cFTOE (59.67 ± 10.37% vs. 64.92 ± 10.16% for crSaO2; 0.37 ± 0.11 vs. 0.32 ± 0.11 for cFTOE) compared to those with no IVH. Significantly lower values of crSaO2 and higher values of cFTOE were found in neonates receiving inotropic treatment (p < 0.0001). Episodes of apnoea also proved to influence the cerebral oxygen saturation of the study group (p = 0.0026). No significant association between the maternal hypertension treatment and the cerebral oxygenation of preterms was found. (4) Conclusions: This study showed a decreased cerebral oxygen saturation of preterms with IVH, inotrope support and apnoea episodes.

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“…Due to their doubtful clinical significance, events <10 sec were ruled out from the study (17). Based on the combination of SpO2/HR nadir and their duration, CRE were defined as mild (duration ≤60 sec and SpO2 nadir 80-84% and/or HR 80-99 bpm or 30-50% below the pre-event baseline), moderate (duration 61-120 sec and/or SpO2 nadir 70-79% and/or HR nadir 60-79 bpm or 50-70% below the pre-event baseline) and severe (duration >120 sec and/or SpO2 nadir <70% and/or HR nadir <60 bpm (22)).…”

Section: Cre Analysismentioning

confidence: 99%

Cardiorespiratory Events in Infants Born Preterm during the Transitional Period

Martini

Frabboni

Rucci

et al. 2020

The Journal of Pediatrics

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Bradycardias are associated with more severe effects on cerebral oxygenation in very preterm infants than in late preterm infants

Cited by 14 publications

References 36 publications

Cardiovascular and cerebrovascular responses to cardio‐respiratory events in preterm infants during the transitional period

Cardiovascular and cerebrovascular responses to cardio‐respiratory events in preterm infants during the transitional period

Association Analysis of the Cerebral Fractional Tissue Oxygen Extraction (cFTOE) and the Cerebral Oxygen Saturation (crSaO2) with Perinatal Factors in Preterm Neonates: A Single Centre Study

Cardiorespiratory Events in Infants Born Preterm during the Transitional Period

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