Cerebral Near-Infrared Spectroscopy during Transition of Healthy Term Newborns

Almaazmi, Munira; Schmid, Manuel; Havers, Stefanie; Reister, Frank; Lindner, Wolfgang; Mayer, Benjamin; Hummler, Helmut; Fuchs, Hans

doi:10.1159/000345926

Cited by 34 publications

(27 citation statements)

References 46 publications

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“…Furthermore, reference values for cerebral StO 2 are presently unclear and probably device specific. For healthy term newborns, we found an interquartile range from 62 to 77% with the FORE-SIGHT oximeter after postnatal adaptation [29], but we do not know if 60% is a reasonable cutoff to define cerebral hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

et al. 2014

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Background: Episodes of hypoxemia and bradycardia frequently occur with apnea of prematurity in preterm infants. Little is known about the impact of different event types on the brain. Objectives: To describe the influence of hypoxemia and bradycardia, either isolated or in combination, on cerebral oxygenation. Methods: In 16 preterm infants with intermittent hypoxemia and/or bradycardia, cerebral tissue oxygen saturation (StO₂, as measured by near-infrared spectroscopy), heart rate and pulse oximetric saturation (SpO₂) were recorded simultaneously for 16 h. Events were classified as isolated bradycardia (type 1), isolated hypoxemia (type 2) or combined (simultaneous, type 3; bradycardia first, type 4; hypoxemia first, type 5). Primary outcome was a score representing the area below baseline for cerebral StO₂ desaturation during an event. Secondary outcomes were duration and depth of cerebral desaturation. Results: Patients had a median (range) gestational age of 25.9 (22.6-30.4) weeks and a postnatal age of 32.5 (7-58) days. The median (quartiles) number of events was 49 (34-58). Isolated hypoxemias were the most frequent events (24; 9-36) and isolated bradycardias the least common (0; 0-1). Cerebral StO₂ baseline was not different between event types. Cerebral desaturation score, duration of event and depth of cerebral desaturation were smallest for isolated bradycardias and largest for combined events, especially for those starting with hypoxemia followed by bradycardia. Regardless of event type, 12/16 infants maintained cerebral StO₂ >60% despite severe SpO₂ desaturations. Conclusions: Isolated bradycardias had the lowest impact on cerebral desaturation, and combined events had the highest. Most infants preserved cerebral oxygenation >60% during events.

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Section: Discussionmentioning

confidence: 99%

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

et al. 2014

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“…Although near-infrared spectroscopy (NIRS) has been applied to noninvasively investigate cerebral and peripheral circulation in various neonatal cases [3,4,5,6,7,8,9,10,11,12], this technique does not provide absolute values of Hb concentration or highly reproducible values of oxygen saturation.…”

Section: Introductionmentioning

confidence: 99%

Difference in Cerebral and Peripheral Hemodynamics among Term and Preterm Infants during the First Three Days of Life

et al. 2014

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Background: The relationship between cerebral and peripheral hemodynamics during the early postnatal period has not been clarified. Objectives: To evaluate cerebral and peripheral oxygenation and blood volumes between term and preterm infants during the first 3 days of life. Materials and Methods: We performed near-infrared time-resolved spectroscopy on 32 term infants (term group) and 40 preterm infants (preterm group), with an optode placed on their forehead and upper arm. The cerebral blood volume (CBV), peripheral blood volume (PBV), cerebral Hb oxygen saturation (cSO₂) and peripheral Hb oxygen saturation (pSO₂) were measured at 3-6, 12, 24, 48 and 72 h after birth. Results: The CBV in the term group (2.45 ± 0.47 ml/100 g) was significantly higher than that in the preterm group (1.97 ± 0.33 ml/100 g). In contrast to the CBV, the PBV in the preterm group (3.63 ± 0.76 ml/100 g) was significantly higher than that in the term group (3.26 ± 0.56 ml/100 g). In the preterm group, there was a significant positive relationship between the CBVs and PBVs at each time point except at 72 h after birth. Despite the differences in blood volumes, there were no differences in the cSO₂ and pSO₂ between the two groups. Conclusions: The contrasting results in the CBV and PBV between the term and preterm infants might be explained by differences in the maturation of the physiological mechanism to control CBV and PBV.

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“…Six studies described sequential measurements of cerebral perfusion using Doppler sonography (table 2) [13,14,15,16,17,18], one of them using continuous monitoring of cerebral tissue oxygenation with near-infrared spectroscopy (NIRS) [17]. Fifteen studies described cerebral oxygenation during neonatal transition using NIRS (table 3) [17,19,20,21,22,23,24,25,26,27,28,29,30,31,32]. One of these studies continuously monitored cerebral activity using amplitude-integrated electroencephalography (aEEG) [32].…”

Section: Resultsmentioning

confidence: 99%

“…vaginal delivery vs. cesarean section) [21,24,25], although significantly lower SpO 2 and heart rate values have been reported in infants born by cesarean section [24]. Interestingly, cerebral tissue oxygen saturation of vaginally delivered neonates shows a decrease of up to 10% in cerebral tissue oxygen saturation accompanied by an increase of FTOE after 8 min of age [17,21,26].…”

Section: Discussionmentioning

confidence: 99%

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How to Monitor the Brain during Immediate Neonatal Transition and Resuscitation: A Systematic Qualitative Review of the Literature

Pichler

Cheung²,

Aziz³

et al. 2014

Neonatology

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Background: The brain is vulnerable to injury and dysfunction during transition after birth in neonates. Clinical assessment of the neurological status immediately following birth is difficult, especially during resuscitation. Objective: Our aim was to review physiological monitoring of the brain during immediate postnatal transition - the first 15 min after birth. Methods: A systematic search of PubMed and EMBASE was performed using the following terms: newborn, neonate, neonates, transition, after-birth, delivery room, cerebral, brain, monitoring, neurology, oxygenation, saturation, activity, imaging, perfusion, Doppler, and blood flow. Additional articles were identified by manual search of cited references. Only human studies describing cerebral changes during the first 15 min after birth were included. Results: Six studies were identified, which described sequential measurements of cerebral perfusion using Doppler sonography, one of these in combination with continuous monitoring of cerebral tissue oxygenation with near-infrared spectroscopy (NIRS). A further 15 studies were identified that used NIRS to continuously monitor cerebral tissue oxygenation. In one study, cerebral activity was continuously monitored with an additional amplitude-integrated encephalogram. Conclusion: Monitoring the brain provides additional information during immediate transition and may help to guide resuscitation. Doppler sonography is technically challenging during resuscitation and is therefore of limited value. NIRS provides continuous monitoring and is feasible even in very-low-birth-weight infants. In the future, an amplitude-integrated encephalogram might give further information on the status of the brain, but before any of these modalities can routinely be recommended during neonatal resuscitation, clinical trials targeting stable brain function parameters are needed.

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Cerebral Near-Infrared Spectroscopy during Transition of Healthy Term Newborns

Cited by 34 publications

References 46 publications

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Difference in Cerebral and Peripheral Hemodynamics among Term and Preterm Infants during the First Three Days of Life

How to Monitor the Brain during Immediate Neonatal Transition and Resuscitation: A Systematic Qualitative Review of the Literature

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