Cardiac Output and Cerebral Oxygenation in Term Neonates during Neonatal Transition

Abstract

The immediate transition from foetus to neonate includes substantial changes, especially concerning the cardiovascular system. Furthermore, the brain is one of the most vulnerable organs to hypoxia during this period. According to current guidelines for postnatal stabilization, the recommended parameters for monitoring are heart rate (HR) and arterial oxygen saturation (SpO2). Recently, there is a growing interest in advanced monitoring of the cardio-circulatory system and the brain to get further objective information about the neonate’s condition during the immediate postnatal transition after birth. The aim of the present study was to combine cardiac output (CO) and brain oxygenation monitoring in term neonates after caesarean section in order to analyse the potential influence of CO on cerebral oxygenation during neonatal transition. This was a monocentric, prospective, observational study. For non-invasive cardiac output measurements, the electrical velocimetry (EV) method (Aesculon Monitor, Osypka Medical, CA, USA) was used. The pulse oximeter probe for SpO2 and HR measurements was placed on the right hand or wrist. The cerebral tissue oxygen index (cTOI) was measured using a NIRO-200NX monitor with the near-infrared spectroscopy (NIRS) transducer on the right frontoparietal head. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, mean CO was calculated from six 10 s periods (with beat-to-beat analysis). During the study period, 99 term neonates were enrolled. Data from neonates with uncomplicated transitions were analysed. CO showed a tendency to decrease until minute 10. During the complete observational period, there was no significant correlation between CO and cTOI. The present study was the first to investigate a possible correlation between CO and cerebral oxygenation in term infants during the immediate neonatal transition. In term infants with uncomplicated neonatal transition after caesarean section, CO did not correlate with cerebral oxygenation.

Three Physiological Components That Influence Regional Cerebral Tissue Oxygen Saturation

“…Furthermore, no significant correlations between rcStO2 and MABP in preterm and term neonates were described ( 79 ). Interestingly, in term neonates with uncomplicated neonatal transition after Cesarean section, rcStO2 did not correlate with CO ( 80 ).…”

In-Silico Evaluation of Anthropomorphic Measurement Variations on Electrical Cardiometry in Neonates

“…This is pertinent in the delivery room. Previous studies used pre-set or standardized weight and length for term infants in the delivery setting [2][3][4][5]. In one study, EC measurements were performed during intact cord management, therefore relying solely on estimates [2].…”

“…Parameters, including stroke volume (SV) and, multiplied by heart rate (HR), cardiac output (CO), are recorded as absolute values or indexed for body weight. While EC is now increasingly used in clinical research in neonates [1], including the delivery room and neonatal intensive care unit [1][2][3][4][5], further research and development of the technology is required before it can be appropriately utilized in clinical practice to potentially guide management.…”

“…Therefore, inaccurate anthropomorphic measurements might affect EC-derived parameters. Measurement is particularly challenging in the delivery room, and in previous studies, predetermined standardized measurements were employed [2][3][4][5]. Inaccuracy may become significant where absolute values are used to delineate 'normative ranges'.…”

Stabilization and Resuscitation of Newborns

“…Advanced monitoring of the cardio-circulatory system and/or the brain provides further information during the neonatal transition after birth. Baik-Schneditz et al [ 13 ] combined non-invasive cardiac output (CO) monitoring by electrical velocimetry and cerebral near-infrared spectroscopy in term newborns after cesarean section, in order to analyze the potential influence of CO on cerebral oxygenation during the neonatal transition. In term infants with uncomplicated neonatal transition after cesarean section, they found no correlation of CO and cerebral oxygenation.…”