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

Abstract

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.

Reference Ranges for Cerebral Tissue Oxygen Saturation Index in Term Neonates during Immediate Neonatal Transition after Birth

“…However, arterial SpO 2 does not provide any information about oxygen tissue delivery. There is a growing interest in monitoring cerebral tissue oxygenation using near-infrared spectroscopy (NIRS) [2]. Several studies using different NIRS devices have described the changes in cerebral regional tissue oxygenation during the first minutes of life [3,4].…”

Transitional Changes in Cerebral Blood Volume at Birth

“…Because of its prognostic importance, there is a special interest in the brain as the most vulnerable organ. Various methods to evaluate cerebral changes during immediate postnatal transition have been described, including Doppler sonography, near-infrared spectroscopy (NIRS) and amplitude-integrated electroencephalography [1]. …”

“…Recently, there has been increasing interest in the continuous monitoring of cerebral transition by NIRS [1]. NIRS is a spectroscopic method that allows non-invasive measurements of the cerebral tissue oxygenation on the one hand, and changes in cerebral haemoglobin concentrations and cerebral blood volume (CBV) on the other, providing information on cerebral haemodynamic processes [2,3].…”

“…NIRS is a spectroscopic method that allows non-invasive measurements of the cerebral tissue oxygenation on the one hand, and changes in cerebral haemoglobin concentrations and cerebral blood volume (CBV) on the other, providing information on cerebral haemodynamic processes [2,3]. It has been shown that NIRS measurements are feasible during the immediate postnatal transition as reviewed by Pichler et al [1]. While all of the available studies have reported on cerebral tissue oxygenation, the behaviour of CBV during transition had not been investigated in humans until now.…”

Anaemia in the Premature Infant and Red Blood Cell Transfusion: New Approaches to an Age-Old Problem

“…This might occur, for example, with low systemic blood flow or with change in position. Reference ranges in term, near term and preterm newborns have been described by a number of researchers [54,55]. Hyttel-Sorensen and colleagues developed a treatment algorithm (SafeBoosC), based on cerebral tissue oxygen saturation, which was then applied in a randomised trial to show an improvement in stability of cerebral oxygenation [56].…”