Preterm infants undergoing laparotomy for necrotizing enterocolitis or spontaneous intestinal perforation display evidence of impaired cerebrovascular autoregulation

Kuik, Sara J; Laan, Michelle E. van der; Brouwer-Bergsma, Margot T.; Hulscher, Jan B F; Absalom, Anthony; Bos, Arend F.; Kooi, Elisabeth M. W.

doi:10.1016/j.earlhumdev.2018.01.019

Cited by 20 publications

(17 citation statements)

References 34 publications

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“…Hyperoxia as a result of increased PaCO 2 levels has also been associated with decreased brain activity as measured with electroencephalography (EEG) [ 68 ]. Cerebrovascular autoregulation is also challenged during hypercarbia [ 69 , 70 , 71 ]. Figure 9 illustrates increased cerebral rSO 2 levels in association with increasing CO 2 levels.…”

Section: Carbon Dioxide: Hypocarbia Versus Hypercarbiamentioning

confidence: 99%

Interpretation of Cerebral Oxygenation Changes in the Preterm Infant

et al. 2018

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Near-infrared spectroscopy (NIRS) allows for continuous, non-invasive monitoring of end-organ tissue oxygenation. The use of NIRS, cerebral NIRS (cNIRS) in particular, in neonatal care has increased significantly over the last few years. This dynamic monitoring technique provides real-time information on the cerebral and haemodynamic status of the neonate and has the potential to serve as an important adjunct to patient care with some centres routinely utilising cNIRS to aid decision-making at the bedside. cNIRS values may be influenced by many variables, including cardiac, respiratory and metabolic parameters, and therefore it is essential to understand the pathophysiology behind alterations in cNIRS values. Correct interpretation is required to direct appropriate patient-specific interventions. This article aims to assist clinicians in deciphering cNIRS values by providing an overview of potential causes of fluctuations in cNIRS values, illustrated by common clinical scenarios, with particular emphasis on the preterm infant.

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Section: Carbon Dioxide: Hypocarbia Versus Hypercarbiamentioning

confidence: 99%

Interpretation of Cerebral Oxygenation Changes in the Preterm Infant

et al. 2018

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“…Of 10 674 abstracts screened, 203 full-text articles were thoroughly examined, and 53 studies were included in the final analysis (figure 1). Of the latter, 21 were designed to address neurodevelopmental outcome and/or neuroimaging abnormalities in NEC survivors,11 12 19–37 and 11 of these were prospective studies 11 20 22 23 26–29 32 35 37…”

Section: Resultsmentioning

confidence: 99%

Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis

Matei

Montalva

Goodbaum

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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AimTo determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC.MethodsSystematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC.ResultsOf 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%–64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001).ConclusionsThis study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC.Trial registration numberCRD42019120522.

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“…Neuromonitoring of the surgical newborn 705 cerebral oxygenation, two studies found no significant changes in BP, 18,32 and the other two studies did not report BP values (Table 4). 19,31 Four studies aimed to find associations between cerebral oxygen desaturation and other peri-operative monitoring techniques.…”

Section: Structured Literature Searchmentioning

confidence: 98%

“…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).…”

Section: Structured Literature Searchmentioning

confidence: 99%

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Towards integrative neuromonitoring of the surgical newborn

Costerus

Hoorn

Hendrikx

et al. 2020

European Journal of Anaesthesiology

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BACKGROUND The altered neurodevelopment of children operated on during the neonatal period might be due to perioperative changes in the homeostasis of brain perfusion. Monitoring of vital signs is a standard of care, but it does not usually include monitoring of the brain. OBJECTIVES To evaluate methods of monitoring the brain that might be of value. We also wanted to clarify if there are specific risk factors that result in peri-operative changes and how this might be evaluated. DESIGN Systematic review. DATA SOURCES A structured literature search was performed in MEDLINE in Ovid, Embase, Cochrane CENTRAL, Web of Science and Google Scholar. ELIGIBILITY CRITERIA Studies in neonates who received peri-operative neuromonitoring were eligible for inclusion; studies on neurosurgical procedures or cardiac surgery with cardiopulmonary bypass and/or deep hypothermia cardiac arrest were excluded. RESULTS Nineteen of the 24 included studies, totalling 374 infants, reported the use of near-infrared spectroscopy. Baseline values of cerebral oxygenation greatly varied (mean 53 to 91%) and consequently, no coherent results were found. Two studies found a correlation between cerebral oxygenation and mean arterial blood pressure. Five studies, with in total 388 infants, used (amplitude-integrated) electroencephalography to study peri-operative brain activity. Overall, the brain activity decreased during anaesthesia and epileptic activity was more frequent in the peri-operative phase. The association between intra-operative cerebral saturation or activity and neuro-imaging abnormalities and/ or neurodevelopmental outcome was investigated in six studies, but no association was found. CONCLUSION Neuromonitoring with the techniques currently used will neither help our understanding of the altered neonatal pathophysiology, nor enable early detection of deviation from the norm. The modalities lack specificity and are not related to clinical (long-term) outcome or prognosis. Accordingly, we were unable to draw up a monitoring guideline.

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Preterm infants undergoing laparotomy for necrotizing enterocolitis or spontaneous intestinal perforation display evidence of impaired cerebrovascular autoregulation

Cited by 20 publications

References 34 publications

Interpretation of Cerebral Oxygenation Changes in the Preterm Infant

Interpretation of Cerebral Oxygenation Changes in the Preterm Infant

Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis

Towards integrative neuromonitoring of the surgical newborn

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