scholarly journals Cerebral oxygenation monitoring of ex-preterm infants during the infant car seat challenge test

2019 ◽  
Vol 25 (5) ◽  
pp. 16-19
Author(s):  
Mansoor Farooqui ◽  
Ganesh Srinivasan ◽  
Yahya Ethawi ◽  
Ruben Alvaro ◽  
John Baier ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Challenge Test ◽  
Oxygen Desaturation ◽  
Car Seat ◽  
Postmenstrual Age ◽  
Systemic Oxygen ◽  
Oxygenation Monitoring ◽  
The Impact

Abstract The American Academy of Pediatrics and until recently the Canadian Paediatric Society recommend preterm infants undergo an Infant Car Seat Challenge test prior to discharge to rule out systemic oxygen desaturation when placed at a 45-degree angle in a car seat. Near-infrared spectroscopy (NIRS) provides objective measurements of the impact of systemic oxygen (SO2) desaturation, bradycardia, or both on cerebral regional oxygen saturation (rSO2). Objective To characterize baseline cerebral rSO2 during a car seat trial in preterm infants ready for discharge. Design/Methods A prospective observational study was performed in 20 infants (32 ± 5 weeks [mean] at a postmenstrual age 37 ± 6 weeks [mean]). Cerebral rSO2 was continuously monitored by placing a NIRS transducer on head during Infant Car Seat Challenge (ICSC). Failure of an ICSC was defined as two SO2 desaturation events below 85% for more than 20 seconds or one event below 80% for 10 seconds. Results The lowest SO2 was 70% with a lowest NIRS recording of 68%. Three infants failed their ICSC, with the lowest rSO2 in these three infants being 68%, above the lowest acceptable limit of 55%. Heart rate but not SO2 appears to influence rSO2 over the range of cerebral oxygenation seen. Conclusions Baseline cerebral rSO2 during ICSC oscillates between 68 and 90%. There were no episodes of significant cerebral oxygen desaturation in studied infants regardless of whether they passed or failed the ICSC. We postulate that former preterm infants are capable through cerebral autoregulation, of maintaining adequate cerebral blood flow in the presence of either systemic oxygen desaturation or bradycardia when they are otherwise ready for discharge.

Cerebral oxygenation monitoring in patients during and after cardiac arrest -- a narrative review of current methods and evidence

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
The Body ◽  
Narrative Review ◽  
Oxygen Balance ◽  
Monitoring Methods ◽  
Venous Oxygen Saturation ◽  
Oxygenation Monitoring ◽  
The Impact

Hypoxic-ischemic brain injury (HIBI) is a leading cause of mortality in post-cardiac arrest (post-CA) patients who successfully survive the initial cardiopulmonary resuscitation (CPR) but later die in the Intensive Care Unit (ICU). Therefore, a key priority of post-resuscitation ICU care is to prevent and limit the impact of HIBI by optimizing the balance between cerebral oxygen delivery and demand. Traditionally, an optimal systemic oxygen balance is considered to ensure the brain’s oxygen balance. However, the validity of this assumption is uncertain, as the brain constitutes only 2%of the body mass while accounting for approximately 20% of basal oxygen consumption at rest. Hence, there is a real need to monitor cerebral oxygenation realistically. Several imaging and bedside monitoring methods are available for cerebral oxygenation monitoring in post-CA patients. Unfortunately, each of them has its limitations. Imaging methods require transporting a critically ill unstable patient to the scanner. Moreover, they provide an assessment of the oxygenation state only at a particular moment, while brain oxygenation is dynamic. Bedside methods, specifically near-infrared spectroscopy (NIRS), brain tissue oxygen tension (PbtO2), and jugular venous oxygen saturation monitoring (SjvO2), have not often been used in studies involving post-CA patients. Hence there is ambiguity regarding clear recommendations for using these bedside monitors. Presently, the most promising option seems to be using the NIRS as an indicator of effective CPR. We present a narrative review focusing on bedside methods and discuss the evidence for their use in adult patients after cardiac arrest.

scholarly journals The utility of cerebral oxygenation monitoring in premature neonates

2020 ◽  
Vol 89 (4) ◽  
pp. e485
Author(s):  
Saudamini Nesargi ◽  
Alexander Nitsch ◽  
Martin Wolf
Keyword(s):  
Infrared Spectroscopy ◽  
Preterm Infants ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Ductus Arteriosus ◽  
Neurological Outcomes ◽  
Standard Set ◽  
Oxygenation Monitoring ◽  
The Brain

Near-infrared spectroscopy allows the measurement of cerebral oxygenation in preterm infants. This study aimed to demonstrate several highly relevant clinical situations in preterm infants in which the standard set of monitoring parameters without near-infrared spectroscopy is not sufficient to detect possible adverse situations, possibly resulting in severe complications, i.e. adverse neurological outcomes. The examples include situations of low blood pressure, persistent open ductus arteriosus, malfunctioning autoregulation of the brain oxygenation, and periods of irregular breathing. Without near-infrared spectroscopy, it is impossible to determine whether such a situation imposes any risk for the brain, whereas the measurement of cerebral oxygenation as an additional source of information enables the clinician to recognise these conditions and modify treatment or use countermeasures to protect the patient from brain damage and ensuing lifelong disabilities.

scholarly journals The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara J. Kuik ◽  
Anne G. J. F. van Zoonen ◽  
Arend F. Bos ◽  
Koenraad N. J. A. Van Braeckel ◽  
Jan B. F. Hulscher ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pilot Study ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Near Infrared ◽  
Regression Analyses ◽  
Signed Rank ◽  
Postmenstrual Age ◽  
Prospective Longitudinal

Abstract Background The factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rintSO2) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rintSO2 affected cerebral oxygen saturation (rcSO2). Methods In a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rcSO2, we also used logistic regression analyses. Results We included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially. Conclusions Our study suggests that postprandial rintSO2 increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands. Trial registration For this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.

The Effect of Antenatal Neuroprotective Magnesium Sulfate Treatment on Cerebral Oxygenation in Preterm Infants

2020 ◽  
Author(s):  
Buse Ozer Bekmez ◽  
Yüksel Oğuz ◽  
Hayriye Gözde Kanmaz Kutman ◽  
Dilek Uygur ◽  
Fuat Emre Canpolat ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Preterm Infants ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Postnatal Life ◽  
Regional Cerebral Oxygen Saturation ◽  
Future Studies ◽  
The Third ◽  
Early Postnatal Life ◽  
Underlying Mechanisms

Abstract Objective Antenatal magnesium sulfate (MgSO4) treatment is associated with reduced risk of cerebral palsy in preterm infants. We aimed to investigate whether this treatment leads to any alterations on cerebral hemodynamics which could be detected by near-infrared spectroscopy (NIRS) readings in early postnatal life. Study design Infants with gestational ages (GAs) ≤ 32 weeks were divided into two groups regarding their exposure to antenatal neuroprotective MgSO4 treatment or not. NIRS monitoring was performed to all infants, and readings were recorded for 2 hours each day during the first 3 days of life. The primary aim was to compare regional cerebral oxygen saturation (rcSO2) and cerebral fractional tissue oxygen extraction (cFTOE) between the groups. Results Sixty-six infants were exposed to antenatal MgSO4, while 64 of them did not. GA and birth weight were significantly lower in the treatment group (p < 0.01). No difference was observed in rcSO2 and cFTOE levels in the first, second, and the third days of life (p > 0.05). An insignificant reduction in severe intraventricular hemorrhage rates was observed (8 vs. 15%, p = 0.24). Conclusion We could not demonstrate any effect on cerebral oxygenation of preterm infants in early postnatal life that could be attributed to antenatal neuroprotective MgSO4 treatment. Future studies are warranted to clarify the exact underlying mechanisms of neuroprotection.

scholarly journals A Longitudinal Description of Heart Rate Variability in 28—34-Week-Old Preterm Infants

2009 ◽  
Vol 11 (3) ◽  
pp. 261-268 ◽  
Author(s):  
Charlene Krueger ◽  
JoHannes H. van Oostrom ◽  
Jonathan Shuster
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Preterm Infants ◽  
High Frequency ◽  
Test Session ◽  
Significant Interaction Effect ◽  
Convenience Sample ◽  
General Linear Model Analysis ◽  
Postmenstrual Age ◽  
The Impact

The purpose of this study was to longitudinally describe changes in heart rate variability (HRV) from 28 to 34 weeks postmenstrual age (PMA). A convenience sample of 31 low-risk preterm infants participated. HRV was quantified using a spectral analysis of heart periods and recorded during seven weekly test sessions from an electrocardiogram (ECG) signal. The total range of frequency components (0.04—2.0 Hz), high-frequency (HF) components (0.30—1.3 Hz), and ratio of low-to-high frequency (LF/HF) components (0.04—0.20/ 0.30—1.3 Hz) were measured. A mixed general linear model analysis revealed no significant change over weekly test sessions for the total, the high, and the ratio of LF/HF components. A significant interaction effect was, however, noted in the HF components for test session × gender (df = 1; F = 4.85; p = .030). With increasing age, the HF components for females increased or displayed a pattern of HRV indicative of a more mature autonomic nervous system (ANS). Study findings warrant further investigation of the impact of gender on normative descriptions of HRV.

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