Correlation between arterial blood pressures and regional cerebral oxygen saturation in preterm neonates during postnatal transition-an observational study

Abstract

ObjectiveTo assess whether blood pressure (systolic (SABP), diastolic (DABP), and mean arterial blood pressure (MABP) and cerebral-regional-oxygen-saturation (crSO2) and cerebral-fractional-tissue-oxygen-extraction (cFTOE) are associated after immediate fetal-to-neonatal transition in preterm neonates with and without respiratory support.Study designPost-hoc analyses of secondary outcome parameters of prospective observational studies were performed. We included moderate and late preterm neonates with and without respiratory support with cerebral NIRS monitoring (INVOS 5100c) and an oscillometric blood pressure measurement at minute 15 after birth. Heart rate (HR) and arterial oxygen saturation (SpO2) were monitored routinely. Blood pressure values were correlated with crSO2 and cFTOE.Results47 preterm neonates with NIRS measurements and blood pressure measurement during immediate transition after birth were included. Twenty-five preterm neonates (gestational age: 34.4±1.6 weeks) received respiratory support. In these neonates crSO2 correlated significantly positively with systolic blood pressure (SABP; r = 0.46, p = 0.021), diastolic blood pressure (DABP; r = 0.51, p = 0.009) and, mean arterial pressure (MABP; r = 0.48, p = 0.015). cFTOE correlated significantly negatively with SABP (r = −0.44, p = 0.027), DABP (r = −0.49, p = 0.013) and mean MABP (r = −0.44, p = 0.029). Twenty-two preterm neonates (gestational age: 34.5 ± 1.5 weeks) did not receive respiratory support. In those neonates, neither crSO2 nor cFTOE correlated with blood pressure.ConclusionIn compromised moderate and late preterm neonates with respiratory support, both, crSO2 and cFTOE correlated with blood pressure. These findings suggest that passive pressure-dependent cerebral perfusion was present in preterm neonates with respiratory support, indicating an impaired cerebral autoregulation in those compromised preterm neonates.

Cardiac output and regional‐cerebral‐oxygen‐saturation in preterm neonates during immediate postnatal transition: An observational study

“…This difference might be explained due to late and moderate preterm neonates that are less likely to require respiratory support compared with very and extremely preterm neonates. Pfurtscheller et al 27 already showed that late and moderate preterm neonates without respiratory support are capable of maintaining cerebral autoregulation compared with late and moderate preterm neonates with respiratory support that is in line with the present findings.…”

Insights into Neonatal Cerebral Autoregulation by Blood Pressure Monitoring and Cerebral Tissue Oxygenation: A Qualitative Systematic Review

“…Blood pressure was measured invasively with an indwelling catheter in 27 [ 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ] studies and non-invasively with oscillometric measurements in 3 studies [ 22 , 49 , 50 ]. In five studies [ 51 , 52 , 53 , 54 , 55 ], both methods were combined, and in one study [ 56 ], the method was unclear.…”

“…Two studies described the association of blood pressure values and cerebral NIRS during immediate transition in preterm and in term neonates [ 22 , 50 ] ( Table 1 ). These studies showed intact cerebral autoregulation in term neonates and impaired cerebral autoregulation in moderate and late preterm neonates receiving respiratory support with significant associations between crSO2/cFTOE and MABP.…”

“…Tissue oxygenation can be monitored by near-infrared spectroscopy (NIRS) [ 17 ] The focus of tissue oxygenation measurements in neonates has been on cerebral tissue oxygenation measurement during the immediate transition [ 18 , 19 ] and at the NICU during the first week after birth [ 20 ]. Some studies in neonates have described that the combination of blood pressure measurements and cerebral NIRS monitoring might be a promising tool due to its potential to reveal information about cerebral autoregulation [ 21 , 22 , 23 ].…”

Acid base and metabolic parameters of the umbilical cord blood and cerebral oxygenation immediately after birth

“…Impaired cerebrovascular autoregulation leads to a pressure-dependent CBF due to its linear correlation with CPP, resulting in deleterious CBF fluctuations in response to CPP variations ( 12 , 25 – 28 ). Several studies have already indicated impaired cerebrovascular autoregulation in compromised preterm neonates ( 25 – 27 , 29 – 33 ). Considering that in the present study cFTOE also tends to be associated with lactate in preterm neonates, low crSO 2 may not only be a result of diminished oxygen content -in terms of low SpO 2 -, but also due to increased oxygen extraction in the cerebral microcirculation.…”