Cerebral near infrared spectroscopy oximetry in extremely preterm infants: phase II randomised clinical trial

Hyttel-Sørensen, Simon; Pellicer, Adelina; Alderliesten, Thomas; Austin, Topun; Bel, Frank van; Benders, Manon J. N. L.; Claris, Olivier; Dempsey, Eugene M.; Franz, Axel R.; Fumagalli, Monica; Gluud, Christian; Grevstad, Berit; Hagmann, Cornelia; Lemmers, Petra; Oeveren, Wim van; Pichler, Gerhard; Plomgaard, Anne Mette; Riera, Joan; Sánchez, Laura; Winkel, Per; Wolf, M.; Greisen, Gorm

doi:10.1136/bmj.g7635

Cited by 248 publications

(251 citation statements)

References 38 publications

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“…Cerebral NIRS oximetry is currently being studied to aid in newborn resuscitation in delivery room 30 , to monitor cerebral autoregulation 31 and daily monitoring in neonatal units 32 , and its role in management in neonatal hypotension 33,34 .…”

Section: Introductionmentioning

confidence: 99%

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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word count: 400 words (maximum 400) Manuscript body word count: 4057 words (maximum 6000) 2 | P a g e AbstractPreterm infants frequently receive blood transfusion during their stay in neonatal unit, and its impact on organ perfusion and oxygenation is not clear. The aim of the study was to measure the effect of blood transfusion on cerebral blood flow and oxygenation in preterm infants in relation to chronological age.Fifty nine infants were studied: group 1=20, group 2=21 and group 3=18 infants with median age (range) at transfusion of 5 (1-7), 14 (8-27) and 45 (29-68) days respectively. Gestational age and birth weight of infants between groups were similar. Pre-transfusion vital parameters were similar between the groups except the heart rate was significantly higher in group 1 compared to group 3 (p=0.02). The mean BP increased significantly in all three groups and there were no significant changes in other vital parameters following transfusion.There was no change in pre and post transfusion pCO2 and pH in blood gas. The mean pretransfusion Anterior Cerebral artery (ACA) time averaged mean velocity (TAMV) increased significantly with chronological age (p<0.001), and ACA Peak Systolic Velocity (PSV) also increased with chronological age of infants but this was not significant. Pre-transfusion ACA TAMV and PSV decreased significantly (p≤0.04), and there was no change in ACA Resistance Index (RI) and Pulsatility Index (PI) following transfusion in infants of all 3 groups. The pre-transfusion mean Superior Vena Cava (SVC) flow decreased significantly in Group 1 (p=0.03) and Group 3 (p<0.001) following transfusion, but the change was not significant in the Group 2 infants (p=0.16). The mean pre-transfusion cerebral tissue oxygenation index (cTOI) levels were significantly lower in group 3 compared to group 1 (p=0.02). The cerebral tissue haemoglobin level cTHI (p<0.001) and cTOI (p<0.05) increased significantly post-transfusion in all the three groups. The percentage increase in post-transfusion cTOI from baseline was 5%, 11% and 12% in group 1, group 2 and group 3 3 | P a g e infants respectively. On comparing infants with PDA (n=14) to gestational and chronological age matched controls (n=14), there was no significant difference in these measurements.Baseline cTOI decrease and ACA TAMV increase with increasing chronological age. Blood transfusion increased cTOI and cTHI, and decreased ACA TAMV in all age group of infants but the proportion of response is different. PDA had no impact on the baseline cerebral oximetry and blood flow as well as changes following transfusion. Future transfusion trials should take into account the impact of postnatal age on cerebral oximetry and blood flow.

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Section: Introductionmentioning

confidence: 99%

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Banerjee

Leung

Aladangady

2016

Early Human Development

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“…Standard color or power Doppler ultrasonography is limited to measuring the velocities in large vessels; so, it is unable to directly assess the vascular regulation that is thought to primarily occur at the level of the capillaries and precapillary arterioles (7). Near infrared spectroscopy monitoring is a promising imaging modality that provides a continuous measure of the regional oxygenation of superficial aspects of the brain (8,9); however, it is unable to directly measure cerebral blood flow. Invasive methods of assessing cerebral perfusion, including 133 xenon clearance measurements, positron emission tomography, single-photon emission computed tomography, and arterial spin labeled perfusion magnetic resonance imaging, are able to better define true cerebral blood flow values, but their clinical value is limited due to the need for sedation and/or radiation.…”

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confidence: 99%

Fast Doppler as a novel bedside measure of cerebral perfusion in preterm infants

et al. 2015

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Background: Altered cerebral perfusion from impaired autoregulation may contribute to the morbidity and mortality associated with premature birth. We hypothesized that fast Doppler imaging could provide a reproducible bedside estimation of cerebral perfusion and autoregulation in preterm infants. Methods: This is a prospective pilot study using fast Doppler ultrasound to assess blood flow velocity in the basal ganglia of 19 subjects born at 26-32 wk gestation. Intraclass correlation provided a measure of test-retest reliability, and linear regression of cerebral blood flow velocity and heart rate or blood pressure allowed for estimations of autoregulatory ability. results: The intraclass correlation when imaging in the first 48 h of life was 0.634. We found significant and independent correlations between the systolic blood flow velocity and both systolic blood pressure and heart rate (P = 0.015 and 0.012 respectively) only in the 26-28 wk gestational age infants in the first 48 h of life. conclusion: Our results suggest that fast Doppler provides reliable bedside measurements of cerebral blood flow velocity at the tissue level in premature infants, acting as a proxy for cerebral tissue perfusion. Additionally, autoregulation appears to be impaired in the extremely preterm infants, even within a normal range of blood pressures.

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“…204 This has led to its use in multiple settings in addition to adult cardiac surgery, including the assessment of visceral perfusion in paediatric cardiac surgery 198 and cerebral oxygenation in neonatal intensive care. 252 It is important, therefore, to consider the negative findings that we have presented. First, we must consider that our results are attributable to chance.…”

Section: Clinical Importancementioning

confidence: 99%

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

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Cerebral near infrared spectroscopy oximetry in extremely preterm infants: phase II randomised clinical trial

Cited by 248 publications

References 38 publications

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

Fast Doppler as a novel bedside measure of cerebral perfusion in preterm infants

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

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