Impact of Cerebral Oxygen Saturation Monitoring on Short-term Neurodevelopmental
Outcomes in Neonates with Encephalopathy - A Prospective
Cohort Study

Tewari, Vishal Vishnu; Kumar, Ashutosh; Kurup, Arjun; Daryani, Hitesh; Saxena, Apoorva

doi:10.2174/1573396318666220304210653

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…Lemmers et al21 noted that healthy infants would maintain their rScO 2 within a documented neuroprotective range of approximately 55% to 85% 21. A similar range was also documented in a study of 120 infants with varying degrees of encephalopathy 17. This study reported that sustaining an rScO 2 between 55% and 85% within the first 72 hours of life was associated with improved neurodevelopmental outcomes 17.…”

Section: Discussionmentioning

confidence: 68%

“…21 A similar range was also documented in a study of 120 infants with varying degrees of encephalopathy. 17 This study reported that sustaining an rScO 2 between 55% and 85% within the first 72 hours of life was associated with improved neurodevelopmental outcomes. 17 rScO 2 trends of term newborns shortly after birth document an average rScO 2 of 77.9% ± 8.5%.…”

Section: Discussionmentioning

confidence: 81%

“…The findings from this systematic review provide a foundation for trending and interpreting cNIRS at the bedside. A normal range of approximately 55% to 85% was identified, while a value of more than 90% was determined to be extremely suspicious for adverse neurological outcomes including brain injury, seizure activity, and death 17,21. These values provide a baseline for evaluating cNIRS at the bedside, as well as when to prompt additional evaluation and intervention.…”

Section: Discussionmentioning

confidence: 99%

“…A normal range of approximately 55% to 85% was identified, while a value of more than 90% was determined to be extremely suspicious for adverse neurological outcomes including brain injury, seizure activity, and death. 17,21 These values provide a baseline for evaluating cNIRS at the bedside, as well as when to prompt additional evaluation and intervention. In my practice using cNIRS as a bedside nurse, an infant's baseline rScO 2 can be manually set on the monitor once the value has stabilized.…”

Section: Recommendations For Practicementioning

confidence: 99%

“…Trending above or below established normal values can indicate dysregulation of cerebral metabolism. 17 A decreasing rScO 2 represents reduced cerebral perfusion to the tissues, while an increasing rScO 2 represents decreased oxygen utilization by the tissues. 18 A desirable rScO 2 value reflects healthy cerebral metabolism, a balance of supply versus demand.…”

mentioning

confidence: 99%

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The Use of Cerebral Near-Infrared Spectroscopy in Neonatal Hypoxic-Ischemic Encephalopathy

Polise,

Newberry

2023

Advances in Neonatal Care

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Background: Cerebral near-infrared spectroscopy (cNIRS) is a noninvasive technology used to trend cerebral perfusion at the bedside. cNIRS has potential as a valuable tool in the evaluation of infants with suspected hypoxic-ischemic encephalopathy (HIE). Trending cerebral perfusion with cNIRS can provide information regarding cerebral metabolism as HIE is evolving, which may offer insight into the extent of brain injury. Purpose: The purpose of this systematic review is to investigate the use of cNIRS as a neurocritical tool in the management of neonatal HIE by evaluating its ability to detect acute neurological compromise, including acute brain injury and seizure activity, as well as its potential to identify infants at high risk for long-term neurodevelopmental impairment. Methods: A literature search was conducted using PubMed, CINAHL, and Web of Science databases to review articles investigating cNIRS technology in the acute management of HIE. Results: Eight studies were identified and included in this systematic review. Correlations were observed between cNIRS trends and neurological outcomes as later detected by MRI. cNIRS has potential as a bedside neuromonitoring tool in the management of HIE to detect infants at high risk for brain injury. Implications for Practice: Existing research supports the value of trending cNIRS in HIE management. Documented normal cNIRS values for both term and preterm infants in the first few days of life is approximately 60% to 80%. A steadily increasing cNIRS reading above an infant's baseline and a value of more than 90% should prompt further evaluation and concern for significant neurological injury.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Recommendations For Practicementioning

confidence: 99%

mentioning

confidence: 99%

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The Use of Cerebral Near-Infrared Spectroscopy in Neonatal Hypoxic-Ischemic Encephalopathy

Polise,

Newberry

2023

Advances in Neonatal Care

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The Inadequate Oxygen Delivery Index and Its Correlation with Venous Saturation in the Pediatric Cardiac Intensive Care Unit

Loomba,

Villarreal,

Flores

et al. 2023

Pediatr Cardiol

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BackgroundContinuous monitoring software, T3, has an integrated index called the inadequate oxygen delivery index 50% (IDO2-50%) which displays a probability that the mixed venous saturation is below a user-selected threshold of 30-50%. The primary aim of this study was to determine the correlation of the IDO2-50% with a measured venous saturation. The secondary aim of this study was to characterize the hemodynamic factors that contributed to the IDO2-50%. MethodsThis single-center, retrospective study aimed to characterize the correlation between IDO2-50% and inferior vena cava (IVC) saturation. A Bayesian Pearson correlation was conducted to assess the correlation between the collected variables of interest, with a particular interest in the correlation between the IDO2-50% and the IVC saturation. Receiver operator curve (ROC) analysis to assess the ability of the IDO2-50% to identify when the venous saturation was less than 50%. Bayesian linear regression was done with the IDO2-50% (dependent variable) and other independent variables. ResultsA total of 113 datasets were collected across 15 unique patients. IDO2-50% and the IVC saturation had moderate correlation with the IVC saturation (correlation coe cient − 0.569). The IDO2-50% had a weak but signi cant correlation with cerebral near infrared spectroscopy (NIRS) values, a weak but signi cant correlation with heart rate, and a moderate and signi cant correlation with arterial saturation. ROC analysis demonstrated that the IDO2-50% had a good ability to identify a venous saturation below 50%, with an area under the curve of 0.797, cutoff point of 24.5 with a sensitivity of 81%, speci city of 66%, positive predictive value of 44% and negative predictive value of 91%. Bayesian linear regression analysis yielded the following model: 237.82 + (1.18 x age in months) -(3.31 x arterial saturation) -(1.92 x cerebral NIRS) + (0.84 x heart rate). ConclusionThe IDO2 index has moderate correlation with IVC saturation. It has good sensitive and negative predictive value. Cerebral NIRS does appear to correlate better with the underlying venous saturation than the IDO2 index.

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Estimation of the inferior caval vein saturation using high-fidelity non-invasive haemodynamic values and validation of modelled estimates

Loomba,

Flores,

Farias

et al. 2024

Cardiol Young

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Objectives: Monitoring venous saturation allows identification of inadequate systemic oxygen delivery. The aim was to develop a model using non-invasive haemodynamic variables to estimate the inferior caval vein saturation and to determine its prognostic utility. Methods: This is a single-centre, retrospective study. A Bayesian Pearson’s correlation was conducted to model the inferior caval vein saturation. Next, a Bayesian linear regression was conducted for data from all the patients and from only those with parallel circulation. Venous saturation estimations were developed. The correlation of these estimates to the actual inferior caval vein saturation was assessed. The resulting models were then applied to two validation cohorts: biventricular circulation (arterial switch operation) and parallel circulation (Norwood operation). Results: One hundred and thirteen datasets were collected across 15 patients. Of which, 65% had parallel circulation. In all patients, the measured and estimated inferior caval vein saturations had a moderate and significant correlation with a coefficient of 0.64. In patients with parallel circulation, the measured and estimated inferior caval vein saturation had a moderate and significant correlation with a coefficient of 0.61. In the biventricular circulation cohort, the estimated inferior caval vein saturation had an area under the curve of 0.71 with an optimal cut-off of 49. In the parallel circulation cohort, the estimated interior caval vein saturation had an area under the curve of 0.83 with an optimal cut-off of 24%. Conclusion: The inferior caval vein saturation can be estimated utilising non-invasive haemodynamic data. This estimate has correlation with measured inferior caval vein saturations and offers prognostic utility.

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Impact of Cerebral Oxygen Saturation Monitoring on Short-term Neurodevelopmental Outcomes in Neonates with Encephalopathy - A Prospective Cohort Study

Cited by 7 publications

References 30 publications

The Use of Cerebral Near-Infrared Spectroscopy in Neonatal Hypoxic-Ischemic Encephalopathy

The Use of Cerebral Near-Infrared Spectroscopy in Neonatal Hypoxic-Ischemic Encephalopathy

The Inadequate Oxygen Delivery Index and Its Correlation with Venous Saturation in the Pediatric Cardiac Intensive Care Unit

Estimation of the inferior caval vein saturation using high-fidelity non-invasive haemodynamic values and validation of modelled estimates

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