Assessment of red blood cell transfusion and transfusion duration on cerebral and mesenteric oxygenation using near-infrared spectroscopy in preterm infants with symptomatic anemia

Near infrared spectroscopy (NIRS) is an imaging-based diagnostic tool that provides non-invasive and continuous evaluation of regional tissue oxygenation in real-time. In recent years, NIRS has shown promise as a useful monitoring technology to help detect relative tissue ischemia that could lead to significant morbidity and mortality in preterm infants. However, some issues inherent in NIRS technology use on neonates, such as wide fluctuation in signals, signal dropout and low limit of detection of the device, pose challenges that may obscure reliable interpretation of the NIRS measurements using current methods of analysis. In this paper, we propose new nonparametric statistical methods to analyze mesenteric rSO2(regional oxygenation) produced by NIRS to evaluate oxygenation in intestinal tissues and investigate oxygenation response to red blood cell transfusion (RBC) in preterm infants. Specifically, we present a mean area under the curve (MAUC) measure and a slope measure to capture the mean rSO2level and temporal trajectory of rSO2, respectively. We develop estimation methods for the measures based on multiple imputation and spline smoothing and further propose novel nonparametric testing procedures to detect RBC-related changes in mesenteric oxygenation in preterm infants. Through simulation studies, we show that the proposed methods demonstrate improved accuracy in characterizing the mean level and changing pattern of mesenteric rSO2and also increased statistical power in detecting RBC-related changes, as compared with standard approaches. We apply our methods to a NIRS study in preterm infants receiving RBC transfusion from Emory University to evaluate the pre- and post-transfusion mesenteric oxygenation in preterm infants.

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Use of Esophageal Hemoximetry to Assess the Effect of Packed Red Blood Cell Transfusion on Gastrointestinal Oxygenation in Newborn Infants

American Journal of Perinatology ◽

10.1055/s-0036-1597993 ◽

2017 ◽

Vol 34 (08) ◽

pp. 735-741 ◽

Cited By ~ 3

Author(s):

Farha Vora ◽

Judy Gates ◽

Kimberley Gerard ◽

Shawn Hanson ◽

Richard Applegate ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Blood Cell ◽

Red Blood Cell ◽

Mesenteric Artery ◽

Near Infrared ◽

Newborn Infants ◽

Red Blood Cell Transfusion ◽

Transabdominal Ultrasound ◽

Flow Measurements ◽

Rapid Changes

Abstract Objectives There are no widely accepted methods of continuously monitoring gut oxygenation in the newborn during packed red blood cell transfusion. We investigated the use of an orally inserted light spectroscopy probe to measure lower esophageal oxyhemoglobin saturations (eStO2) before, during, and after transfusion and made comparisons with abdominal near-infrared spectroscopy (NIRS) and superior mesenteric artery (SMA) flow. Study Design Thirteen neonates with corrected gestational ages ranging from 22 weeks, 0 day to 37 weeks, 5 days were enrolled. eStO2 and NIRS measurements were recorded continuously for a 25-hour period starting 1 hour prior to starting the 4-hour transfusion. Transabdominal ultrasound was used to measure SMA flow prior to, upon completion, and 20 hours after the transfusion. Results Twelve infants completed the study. eStO2 was well-tolerated and was weakly (r = 0.06) correlated (p < 0.001) with NIRS. Compared with NIRS, eStO2 demonstrated a markedly greater variation in oxyhemoglobin values. NIRS and SMA flow measurements did not change, while eStO2 increased from 48 ± 5% and 45 ± 5% in the pre- and intratransfusion periods to 57 ± 4% in the posttransfusion period (p = 0.03). Conclusion Measurement of eStO2 is feasible in neonates and may provide a continuous and sensitive index of rapid changes in mesenteric oxygenation in this patient population.

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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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