Monitoring Cerebral and Renal Oxygenation Status during Neonatal Digestive Surgeries Using Near Infrared Spectroscopy

Abstract

BackgroundDepending on the initial pathology, hypovolemia, intra-abdominal hypertension, and sepsis are often encountered in neonatal digestive surgery. Accurate newborn monitoring during and after surgery is essential to adapt resuscitation protocols. Near infrared spectroscopy (NIRS) is non-invasive and can detect hypoperfusion which indicates a low circulatory blood flow, regardless of the cause.ObjectiveEvaluating changes in cerebral and renal regional oxygen saturation during neonatal digestive surgeries, conducted according to normal practices, with commonly used monitoring parameters. Analyzing retrospectively the inter-relationships between NIRS values and mean arterial pressure (MAP) values as well as pre-ductal SpO2.MethodsProspective, descriptive, monocentric study. All neonates referred for surgery were included. NIRS allows the measurement of cerebral and renal oxygenation fluctuations, as well as calculating difference in intraoperative and postoperative values.ResultsNineteen patients were included. Cerebral regional oxygen saturation (C rSO2) values were stable while renal regional oxygen saturation (R rSO2) values tended to decrease with time during surgery. Indeed, 72% of rSO2 decline episodes occurred after the first 30 min of surgery, without any significant statistical differences for the next 90 min of surgery. After surgery, the lowest average C and R rSO2 values were evidenced during the first 6 h, with 60% of C rSO2 and R rSO2 anomalies occurring in that time frame. There was no significant statistical difference observed in the following 18 h. There was a significant correlation between R rSO2 and SpO2 values (p < 0.01), but not with C rSO2 values. There was no correlation with the MAP either for the C rSO2 values or R rSO2 ones.ConclusionNIRS is a promising non-invasive bedside tool to monitor cerebral and tissue perfusion, analyzing tissue microcirculation. NIRS has its interest to guide neonatal digestive surgeries (bowel manipulation, viscera reduction) and may represent an early warning for identifying patients requiring resuscitation during or after these surgeries.

Advances in translational imaging of the microcirculation

“…89 In contrast to the technologies described above, NIRS is an indirect optical imaging modality because it does not provide direct visualization of the microvasculature. The main organs interrogated with NIRS are the brain and skeletal muscle, [90][91][92] although it has also been used to image the adult bladder, 93 pediatric kidneys, 94,95 abdominal/mesentery, 95,96 and liver. 97 For NIRS imaging, oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) are the dominant chromophores in human tissue that dynamically change over time.…”

Towards integrative neuromonitoring of the surgical newborn

“…Nineteen studies used NIRS. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Fourteen of these measured only cerebral oxygenation and five combined cerebral oxygenation with cerebral blood flow (CBF) or cerebral autoregulation (Table 1). Five studies used aEEG -in four to measure cerebral activity [33][34][35][36] and in one, a large cohort study, to detect epileptic activity only (Table 2).…”

“…Near-infrared spectroscopy: correlations with other physiological variables In the five studies that reported a decrease of cerebral oxygenation, three reported no significant changes in blood pressure (BP) 15,16,27 and two did not report BP values. 24,28 In the four studies that reported an increase in Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.…”

“…19,31 Four studies aimed to find associations between cerebral oxygen desaturation and other peri-operative monitoring techniques. 22,25,26,28 One of these investigated the applicability of NIRS in neonates undergoing noncardiac surgery by comparing the event rate of hypoxia (defined as SpO 2 < 90%) measured with the conventional peripheral pulse oximeter with the event rate of hypoxia measured with NIRS (defined as >20% decline from cerebral oxygen saturation (rSO 2 ) baseline or an absolute decline in rSO 2 less than 40%, lasting for a minimum of 3 min) and found that NIRS events occurred two to three times more often than hypoxia measured with the conventional peripheral pulse oximeter. During desaturation, the decline in SpO 2 was similar to that of rSO 2 in pattern and duration.…”

“…22 By contrast, the fourth study, with 19 neonates during a variety of surgical procedures, reported intra-operative desaturation (defined as delta rSO 2 > 20% from baseline) in six (6.7%) of the measurement points and did not find a correlation between mean arterial BP and cerebral rSO 2 . 28 An overview of physiological variables correlated with NIRS are shown in Appendix 3, http://links.lww.com/EJA/ A308.…”