Titration of inspired oxygen in preterm infants with hypoxemic respiratory failure using near‐infrared spectroscopy and pulse oximetry: A new approach

Titration of Inspired Oxygen in Preterm Infants with Hypoxemic Respiratory Failure Using Near Infrared Spectroscopy and Pulse Oximetry: A New Approach

10.22541/au.162108994.48186029/v1 ◽

2021 ◽

Author(s):

Yasser Elsayed ◽

Shyamala Dakshinamurti

Keyword(s):

Infrared Spectroscopy ◽

Respiratory Failure ◽

Preterm Infants ◽

Near Infrared Spectroscopy ◽

Cerebral Autoregulation ◽

Near Infrared ◽

Tissue Oxygen ◽

Hypoxemic Respiratory Failure ◽

Integrated Monitoring ◽

Inspired Oxygen

Background: Titration of inspired oxygen is a challenge in preterm infants with hypoxemic respiratory failure (HRF). Monitoring of brain oxygen by near infrared spectroscopy (NIRS) has been proven to minimize the burden of hyperoxia and hypoxemia, with better understanding of cerebral autoregulation (CAR). integrating NIRS and pulse oximetry (SpO2) for titrating inspired oxygen is a novel approach. Methods: We aimed to study the impact of integrated monitoring of oxygen saturation by SpO2 and cerebral regional tissue oxygen (crRTO) by NIRS during oxygen reduction test (ORT) on reducing oxygen requirement in preterm infants with HRF. The correlation between SpO2 with crRTO, and fractional oxygen extraction (FOE) was assessed, concordance levels (r>0.5) were determined during the assessment period, and was considered as a sign of impaired autoregulation. The primary outcome was the achievement of significantly lower FiO2 at 72 hours after start of the integrated monitoring. Results: Total of 38 preterm infants were included, 27 had normal cerebral autoregulation (CAR), (group 1) in whom SpO2 was poorly correlating with cerebral regional tissue oxygen (crRTO) with (r<0.5) and had significantly greater percentage of reduction below baseline in FiO2 (Mean:34%). Eleven infants had impaired CAR (group 2) with SpO2 significantly correlating with crRTO (r>0.5) and had a linear trend of FOE inverse to SpO2 and crRTO; this was considered as an arterial saturation dependent oxygen delivery (SadDO2). Conclusion: Integrated monitoring of preterm infants by SpO2 and crRTO was associated with easier weaning of oxygen with less burden of both hyperoxia and hypoxemia.

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Faculty Opinions recommendation of Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718509845.793511009 ◽

2015 ◽

Author(s):

Agostino Pierro

Keyword(s):

At Risk ◽

Infrared Spectroscopy ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Near Infrared Spectroscopy ◽

Near Infrared

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Near-Infrared Spectroscopy in Extremely Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2020.624113 ◽

2021 ◽

Vol 8 ◽

Author(s):

Leeann R. Pavlek ◽

Clifford Mueller ◽

Maria R. Jebbia ◽

Matthew J. Kielt ◽

Omid Fathi

Keyword(s):

Infrared Spectroscopy ◽

Preterm Infants ◽

Near Infrared Spectroscopy ◽

Neonatal Intensive Care ◽

Near Infrared ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Potential Applications

With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22–24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.

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