scholarly journals Neonatal Hemoglobin Levels in Preterm Infants Are Associated with Early Neurological Functioning

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Willemien S. Kalteren ◽  
Mirthe J. Mebius ◽  
Elise A. Verhagen ◽  
Jozien C. Tanis ◽  
Elisabeth M.W. Kooi ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Tissue Oxygen Saturation ◽  
Strongly Correlated ◽  
Neurological Functioning ◽  
Grade Ii ◽  
Explained Variance ◽  
General Movement ◽  
Median Birth Weight

<b><i>Background:</i></b> Neonatal anemia may compromise oxygen transport to the brain. The effects of anemia and cerebral oxygenation on neurological functioning in the early neonatal period are largely unknown. <b><i>Objective:</i></b> This study aimed to determine the association between initial hemoglobin levels (Hb) and early neurological functioning in preterm infants by assessing their general movements (GMs). <b><i>Methods:</i></b> A retrospective analysis of prospectively collected data on preterm infants born before 32 weeks of gestation was conducted. We excluded infants with intraventricular hemorrhage &#x3e; grade II. On day 8, we assessed infants’ GMs, both generally as normal/abnormal and in detail using the general movement optimality score (GMOS). We measured cerebral tissue oxygen saturation (r<sub>c</sub>SO<sub>2</sub>) on day 1 using near-infrared spectroscopy. <b><i>Results:</i></b> We included 65 infants (median gestational age 29.9 weeks [IQR 28.2–31.0]; median birth weight 1,180 g [IQR 930–1,400]). Median Hb on day 1 was 10.3 mmol/L (range 4.2–13.7). Lower Hb on day 1 was associated with a higher risk of abnormal GMs (OR = 2.3, 95% CI: 1.3–4.1) and poorer GMOSs (<i>B</i> = 0.9, 95% CI: 0.2–1.7). Hemoglobin strongly correlated with r<sub>c</sub>SO<sub>2</sub> (rho = 0.62, <i>p</i> &#x3c; 0.01). Infants with lower r<sub>c</sub>SO<sub>2</sub> values tended to have a higher risk of abnormal GMs (<i>p</i> = 0.06). After adjusting for confounders, Hb on day 1 explained 44% of the variance of normal/abnormal GMs and r<sub>c</sub>SO<sub>2</sub> explained 17%. Regarding the explained variance of the GMOS, this was 25% and 16%, respectively. <b><i>Conclusions:</i></b> In preterm infants, low Hb on day 1 is associated with impaired neurological functioning on day 8, which is partly explained by low cerebral oxygenation.

Red Blood Cell Transfusions Affect Intestinal and Cerebral Oxygenation Differently in Preterm Infants with and without Subsequent Necrotizing Enterocolitis

2018 ◽  
Vol 35 (11) ◽  
pp. 1031-1037 ◽  
Author(s):  
Sara Kuik ◽  
Koenraad Van Braeckel ◽  
Jan Hulscher ◽  
Arend Bos ◽  
Elisabeth Kooi ◽  
...  
Keyword(s):  
Blood Cell ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Red Blood Cell ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Tissue Oxygen Saturation ◽  
Short Term ◽  
Diminished Capacity ◽  
Red Blood Cell Transfusions

Objective To assess intestinal and cerebral oxygenation during and after red blood cell (RBC) transfusions in preterms with or without subsequent transfusion-associated necrotizing enterocolitis (TANEC). Study Design In preterms of < 32 weeks' gestational age, we measured intestinal and cerebral regional tissue oxygen saturation (rintSO2, rcSO2) and their variabilities using near-infrared spectroscopy during and after transfusions. We compared eight infants who developed TANEC 6 to 48 hours after RBC transfusions with 16 controls. Results In TANEC infants, rcSO2 was lower during and after RBC transfusions than in controls, median (interquartile range) 55% (50–62) versus 72% (65–75), p < 0.01. There were no differences regarding rintSO2. Individual rintSO2 and rcSO2 ranges were smaller after transfusions in TANEC infants, 28% (9–36) versus 49% (40–65), p < 0.01, and 17% (14–33) versus 36% (26–57), p = 0.01, as was short-term rintSO2 variability. For each 10% higher rcSO2, the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01–0.63). The smaller the rintSO2 range after transfusion, the higher the risk of developing TANEC. Conclusion In preterm infants lower rcSO2, but not rintSO2, values during and after RBC transfusions are associated with TANEC. Lower rintSO2 and rcSO2 variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.

scholarly journals Near-Infrared Spectroscopy in Extremely Preterm Infants

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.

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 Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 205
Author(s):  
Marlies Bruckner ◽  
Lukas P. Mileder ◽  
Alisa Richter ◽  
Nariae Baik-Schneditz ◽  
Bernhard Schwaberger ◽  
...  
Keyword(s):  
Body Temperature ◽  
Caesarean Section ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Near Infrared ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Secondary Outcome ◽  
Tissue Oxygen Saturation ◽  
Preterm Neonates

Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO2/cTOI and prSO2), arterial oxygen saturation (SpO2), and heart rate (HR). The secondary outcome parameters of five prospective observational studies are analyzed. We include preterm and term neonates born by Caesarean section who received continuous pulse oximetry and near-infrared spectroscopy monitoring during the first 15 min, and a rectal BT measurement once in minute 15 after birth. Four-hundred seventeen term and 169 preterm neonates are included. The BT did not correlate with crSO2/cTOI and SpO2. The BT correlated with the HR in all neonates (ρ = 0.210, p < 0.001) and with prSO2 only in preterm neonates (ρ = −0.285, p = 0.020). The BT was lower in preterm compared to term infants (36.7 [36.4–37.0] vs. 36.8 [36.6–37.0], p = 0.001) and prevalence of hypothermia was higher in preterm neonates (29.5% vs. 12.0%, p < 0.001). To conclude, the BT did not correlate with SpO2 and crSO2/cTOI, however, there was a weak positive correlation between the BT and the HR in the whole cohort and a weak correlation between the BT and prSO2 only in preterm infants. Preterm neonates had a statistically lower BT and suffered significantly more often from hypothermia during postnatal transition.

Effects of Single Loading Dose of Intravenous Caffeine on Cerebral Oxygenation in Preterm Infants

2020 ◽  
Author(s):  
Ozkan Ilhan ◽  
Meltem Bor
Keyword(s):  
Preterm Infants ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Clinical Importance ◽  
Oxygen Extraction ◽  
Loading Dose ◽  
Tissue Oxygen ◽  
Cerebral Tissue ◽  
Baseline Values ◽  
A Prospective Study

Abstract Objective The aim of this study was to evaluate the effects of caffeine on cerebral oxygenation in preterm infants. Study Design This was a prospective study of infants with a gestational age (GA) of < 34 weeks who were treated intravenously with a loading dose of 20 mg/kg caffeine citrate within the first 48 hours of life. Regional cerebral oxygen saturation (rSO2C) and cerebral fractional tissue oxygen extraction (cFTOE) were measured using near-infrared spectroscopy before administering caffeine (baseline), immediately after administering caffeine, and 1, 2, 3, 4, 6, and 12 hours after dose completion; postdose values were compared with the baseline values. Results A total of 48 infants with a mean GA of 29.0 ± 1.9 weeks, birth weight of 1,286 ± 301 g, and postnatal age of 32.4 ± 11.3 hours were included in the study. rSO2C significantly decreased from 81.3 to 76.7% soon after administering caffeine, to 77.1% at 1 hour, and to 77.8% at 2 hours with recovery at 3 hours postdose. rSO2C was 80.2% at 12 hours postdose. cFTOE increased correspondingly. Although rSO2C values were lower and cFTOE values were higher compared with the baseline values at 3, 4, 6, and 12 hours after caffeine administration, this was not statistically significant. Conclusion A loading dose of caffeine temporarily reduces cerebral oxygenation and increases cerebral tissue oxygen extraction in preterm infants. Most probably these changes reflect a physiological phenomenon without any clinical importance to the cerebral hemodynamics, as the reduction in cerebral oxygenation and increase in cerebral tissue oxygen extraction remain well within acceptable range.

scholarly journals Prenatal Use of Sildenafil in Fetal Growth Restriction and Its Effect on Neonatal Tissue Oxygenation—A Retrospective Analysis of Hemodynamic Data From Participants of the Dutch STRIDER Trial

2020 ◽  
Vol 8 ◽  
Author(s):  
Fieke Terstappen ◽  
Anne E. Richter ◽  
A. Titia Lely ◽  
Freek E. Hoebeek ◽  
Ayten Elvan-Taspinar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Growth Restriction ◽  
Tissue Oxygen Saturation

Objective: Sildenafil is under investigation as a potential agent to improve uteroplacental perfusion in fetal growth restriction (FGR). However, the STRIDER RCT was halted after interim analysis due to futility and higher rates of persistent pulmonary hypertension and mortality in sildenafil-exposed neonates. This hypothesis-generating study within the Dutch STRIDER trial sought to understand what happened to these neonates by studying their regional tissue oxygen saturation (rSO2) within the first 72 h after birth.Methods: Pregnant women with FGR received 25 mg placebo or sildenafil thrice daily within the Dutch STRIDER trial. We retrospectively analyzed the cerebral and renal rSO2 monitored with near-infrared spectroscopy (NIRS) in a subset of neonates admitted to two participating neonatal intensive care units, in which NIRS is part of standard care. Secondarily, blood pressure and heart rate were analyzed to aid interpretation. Differences in oxygenation levels and interaction with time (slope) between placebo- and sildenafil-exposed groups were tested using mixed effects analyses with multiple comparisons tests.Results: Cerebral rSO2 levels were not different between treatment groups (79 vs. 77%; both n = 14) with comparable slopes. Sildenafil-exposed infants (n = 5) showed lower renal rSO2 than placebo-exposed infants (n = 6) during several time intervals on day one and two. At 69–72 h, however, the sildenafil group showed higher renal rSO2 than the placebo group. Initially, diastolic blood pressure was higher and heart rate lower in the sildenafil than the placebo group, which changed during day two.Conclusions: Although limited by sample size, our data suggest that prenatal sildenafil alters renal but not cerebral oxygenation in FGR neonates during the first 72 post-natal hours. The observed changes in renal oxygenation could reflect a vasoconstrictive rebound from sildenafil. Similar changes observed in accompanying vital parameters support this hypothesis.

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

2020 ◽  
Author(s):  
Julia Le Bouhellec ◽  
Olivier Prodhomme ◽  
Thibault Mura ◽  
Aurélien Jacquot ◽  
Clémentine Combes ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Necrotizing Enterocolitis ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Gastrointestinal Symptoms ◽  
Abdominal Distension ◽  
Tissue Oxygen Saturation ◽  
Preterm Neonates ◽  
Nirs Data

Abstract Objective In premature neonates, bloody stools and/or abdominal distension with feeding intolerance may be inaugural signs of necrotizing enterocolitis (NEC). We assessed the ability of near-infrared spectroscopy (NIRS) to distinguish those neonates with NEC soon after the occurrence of these symptoms. Study Design We prospectively collected NIRS measurements of abdominal and cerebral regional tissue oxygen saturation (r-SO2), with values masked by an opaque cover. Two physicians, blinded to the NIRS data, determined whether the gastrointestinal symptoms were related to NEC 10 days after symptom onset. Results Forty-five neonates with mean (standard deviation [SD]) gestational, birth weight and postnatal ages of 31 (3.9) weeks, 1,486 (794) g, and 18 (14) days were enrolled over 30 months. Gastrointestinal symptoms were related to NEC in 23 patients and associated with other causes in 22. Analysis of the 48 hours of monitoring revealed comparable abdominal r-SO2 and splanchnic-cerebral oxygenation ratio (SCOR) in patients with and without NEC (r-SO2: 47.3 [20.4] vs. 50.4 [17.8], p = 0.59, SCOR: 0.64 [0.26] vs. 0.69 [0.24], p = 0.51). Results were unchanged after NIRS analysis in 6-hour periods, and restriction of the analysis to severe NEC (i.e., grade 2 and 3, 57% of the NEC cases). Conclusion In this study, NIRS monitoring was unable to individualize NEC in premature infants with acute gastrointestinal symptoms.

Sign in / Sign up

Export Citation Format

Share Document