Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life

Beausoleil, Thierry P.; Janaillac, Marie; Barrington, Keith J.; Lapointe, Anie; Dehaes, Mathieu

doi:10.1038/s41598-018-24836-8

Cited by 19 publications

(17 citation statements)

References 90 publications

(124 reference statements)

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“…We calculated wavelet and correlation indices in the same piglets during identical physiologic changes from induced hypotension. Clinical neonatal wavelet NIRS methods have also been studied in hypoxic-ischemic encephalopathy 21,22 and prematurity 23 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of wavelet and correlation indices of cerebral autoregulation in a pediatric swine model of cardiac arrest

Liu

Brady

et al. 2020

Sci Rep

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Existing cerebrovascular blood pressure autoregulation metrics have not been translated to clinical care for pediatric cardiac arrest, in part because signal noise causes high index time-variability. We tested whether a wavelet method that uses near-infrared spectroscopy (NIRS) or intracranial pressure (ICP) decreases index variability compared to that of commonly used correlation indices. We also compared whether the methods identify the optimal arterial blood pressure (ABPopt) and lower limit of autoregulation (LLA). 68 piglets were randomized to cardiac arrest or sham procedure with continuous monitoring of cerebral blood flow using laser Doppler, NIRS and ICP. The arterial blood pressure (ABP) was gradually reduced until it dropped to below the LLA. Several autoregulation indices were calculated using correlation and wavelet methods, including the pressure reactivity index (PRx and wPRx), cerebral oximetry index (COx and wCOx), and hemoglobin volume index (HVx and wHVx). Wavelet methodology had less index variability with smaller standard deviations. Both wavelet and correlation methods distinguished functional autoregulation (ABP above LLA) from dysfunctional autoregulation (ABP below the LLA). Both wavelet and correlation methods also identified ABPopt with high agreement. Thus, wavelet methodology using NIRS may offer an accurate vasoreactivity monitoring method with reduced signal noise after pediatric cardiac arrest.Cerebrovascular autoregulation constrains cerebral blood flow across fluctuations in cerebral perfusion pressure (CPP). It is mediated by vasoreactivity with changes in cerebrovascular resistance. Autoregulation may become dysfunctional after cardiac arrest, traumatic brain injury, and elevated intracranial pressure (ICP) 1-6 with shifts in the limits of blood pressure autoregulation. Methods to identify and target the blood pressure range that supports autoregulation could reduce secondary neurologic injury.The optimal mean arterial blood pressure (ABPopt) at which autoregulatory vasoreactivity is most robust varies after pediatric hypoxic brain injury 4,7-9 . Targeting the optimal CPP may improve neurologic outcomes after adult traumatic brain injury 5,10 . However, the ABPopt must be used after pediatric cardiac arrest because invasive ICP monitoring is not routinely performed in this population. Maintaining blood pressure close to ABPopt is associated with less neurologic injury in infants and children at risk of hypoxic brain injury, including those resuscitated from cardiac arrest 4,11 and those with hypoxic-ischemic encephalopathy 7-9 , prematurity 12 , or moyamoya vasculopathy 13 .

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Section: Discussionmentioning

confidence: 99%

Comparison of wavelet and correlation indices of cerebral autoregulation in a pediatric swine model of cardiac arrest

Liu

Brady

et al. 2020

Sci Rep

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“…9 First, extremely premature infants lack adequate cerebral autoregulation compared with more mature preterm infants. Beausoleil et al 10 analyzed cerebral autoregulation, as assessed by near infrared spectroscopy, and demonstrated that cerebral perfusion can fluctuate based on systemic blood pressure greater than 50% of the time in extremely preterm infants compared with 20% of the time in very preterm infants. 11 Changes in systemic blood flow with umbilical cord milking may be transferred to the cerebral blood flow causing rupture.…”

Section: Discussionmentioning

confidence: 99%

Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants

Katheria

Reister

Essers

et al. 2019

JAMA

207

130

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IMPORTANCE Umbilical cord milking as an alternative to delayed umbilical cord clamping may provide equivalent benefits to preterm infants, but without delaying resuscitation. OBJECTIVE To determine whether the rates of death or severe intraventricular hemorrhage differ among preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping. DESIGN, SETTING, AND PARTICIPANTS Noninferiority randomized clinical trial of preterm infants (born at 23-31 weeks' gestation) from 9 university and private medical centers in 4 countries were recruited and enrolled between June 2017 and September 2018. Planned enrollment was 750 per group. However, a safety signal comprising an imbalance in the number of severe intraventricular hemorrhage events by study group was observed at the first interim analysis; enrollment was stopped based on recommendations from the data and safety monitoring board. The planned noninferiority analysis could not be conducted and a post hoc comparison was performed instead. Final date of follow-up was December 2018. INTERVENTIONS Participants were randomized to umbilical cord milking (n = 236) or delayed umbilical cord clamping (n = 238). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or severe intraventricular hemorrhage to determine noninferiority of umbilical cord milking with a 1% noninferiority margin. RESULTS Among 540 infants randomized, 474 (88%) were enrolled and completed the trial (mean gestational age of 28 weeks; 46% female). Twelve percent (29/236) of the umbilical cord milking group died or developed severe intraventricular hemorrhage compared with 8% (20/238) of the delayed umbilical cord clamping group (risk difference, 4% [95% CI, −2% to 9%]; P = .16). Although there was no statistically significant difference in death, severe intraventricular hemorrhage was statistically significantly higher in the umbilical cord milking group than in the delayed umbilical cord clamping group (8% [20/236] vs 3% [8/238], respectively; risk difference, 5% [95% CI, 1% to 9%]; P = .02). The test for interaction between gestational age strata and treatment group was significant for severe intraventricular hemorrhage only (P = .003); among infants born at 23 to 27 weeks' gestation, severe intraventricular hemorrhage was statistically significantly higher with umbilical cord milking than with delayed umbilical cord clamping (22% [20/93] vs 6% [5/89], respectively; risk difference, 16% [95% CI, 6% to 26%]; P = .002). CONCLUSIONS AND RELEVANCE In this post hoc analysis of a prematurely terminated randomized clinical trial of umbilical cord milking vs delayed umbilical cord clamping among preterm infants born at less than 32 weeks' gestation, there was no statistically significant difference in the rate of a composite outcome of death or severe intraventricular hemorrhage, but there was a statistically significantly higher rate of severe intraventricular hemorrhage in the umbilical cord milking group. The early study termination and resulti...

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“…Maintaining optimal perfusion and oxygenation is of prime concern in neonatal intensive care units (NICU). Comprehensive monitoring of various physiological variables is required, as low CO has been associated with increased morbidity, adverse neurodevelopmental outcome, and increased mortality ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Accuracy and Trending Ability of Electrical Biosensing Technology for Non-invasive Cardiac Output Monitoring in Neonates: A Systematic Qualitative Review

et al. 2022

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BackgroundElectrical biosensing technology (EBT) is an umbrella term for non-invasive technology utilizing the body’s fluctuating resistance to electrical current flow to estimate cardiac output. Monitoring cardiac output in neonates may allow for timely recognition of hemodynamic compromise and allow for prompt therapy, thereby mitigating adverse outcomes. For a new technology to be safely used in the clinical environment for therapeutic decisions, it must be proven to be accurate, precise and be able to track temporal changes. The aim of this systematic review was to identify and analyze studies that describe the accuracy, precision, and trending ability of EBT to non-invasively monitor Left ventricular cardiac output and/or stroke volume in neonates.MethodsA qualitative systematic review was performed. Studies were identified from PubMed NCBI, SCOPUS, and EBSCOHost up to November 2021, where EBT technologies were analyzed in neonates, in comparison to a reference technology. Outcome measures were bias, limits of agreement, percentage error for agreement studies and data from 4-quadrant and polar plots for trending studies. Effect direction plots were used to present results.ResultsFifteen neonatal studies were identified, 14 for agreement and 1 for trending analysis. Only thoracic electrical biosensing technology (TEBT), with transthoracic echocardiography (TTE) as the comparator, studies were available for analyzes. High heterogeneity existed between studies. An equal number of studies showed over- and underestimation of left ventricular output parameters. All studies showed small bias, wide limits of agreement, with most studies having a percentage error >30%. Sub-analyses for respiratory support mode, cardiac anomalies and type of technology showed similar results. The single trending study showed poor concordance, high angular bias, and poor angular concordance.DiscussionOverall, TEBT shows reasonable accuracy, poor precision, and non-interchangeability with TTE. However, high heterogeneity hampered proper analysis. TEBT should be used with caution in the neonatal population for monitoring and determining therapeutic interventions. The use of TEBT trend monitoring has not been sufficiently studied and requires further evaluation in future trials.

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Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life

Cited by 19 publications

References 90 publications

Comparison of wavelet and correlation indices of cerebral autoregulation in a pediatric swine model of cardiac arrest

Comparison of wavelet and correlation indices of cerebral autoregulation in a pediatric swine model of cardiac arrest

Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants

Accuracy and Trending Ability of Electrical Biosensing Technology for Non-invasive Cardiac Output Monitoring in Neonates: A Systematic Qualitative Review

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