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

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.

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Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

Neonatology ◽

10.1159/000494462 ◽

2019 ◽

Vol 115 (3) ◽

pp. 198-204 ◽

Cited By ~ 5

Author(s):

Francesco Bonsante ◽

Duksha Ramful ◽

Christine Binquet ◽

Sylvain Samperiz ◽

Sandrine Daniel ◽

...

Keyword(s):

Acute Kidney Injury ◽

Infrared Spectroscopy ◽

Oxygen Saturation ◽

Preterm Infants ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Kidney Injury ◽

Very Preterm Infants ◽

Very Preterm ◽

Renal Oxygen

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

Children ◽

10.3390/children7110205 ◽

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.

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Abstract 14185: Targeting Lower Oxygen Saturation Parameters in Premature Infants Does Not Increase Incidence of Pulmonary Hypertension in the Neonatal Intensive Care Unit

Circulation ◽

10.1161/circ.142.suppl_3.14185 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Maria Niccum ◽

Fotios Spyropoulos ◽

Jonathan Levin ◽

Carter Petty ◽

Mary P Mullen ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Logistic Regression ◽

Birth Weight ◽

Oxygen Saturation ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Positive Association ◽

Increased Risk ◽

Significant Difference ◽

Lower Oxygen

Introduction: Lower oxygen saturation targets in preterm infants have been associated with decreased incidence of bronchopulmonary dysplasia (BPD) but increased risk of pulmonary hypertension (PH). Studies have shown that targets of <90% are associated with higher incidence of PH, however data on the optimal saturation target >90% are lacking. In this study, we compared the rate of BPD and PH in two cohorts with saturation targets of 94-98% and 92-97%. We hypothesized that BPD rate would be lower and PH rate would be unchanged at the lower saturation target. Methods: We performed a retrospective cohort study comparing PH and BPD rates among two cohorts of infants born at ≤32 weeks gestation at Brigham and Women’s Hospital: cohort 1 with saturation target of 94-98% (n = 129, July 2017-July 2018), cohort 2 with saturation target of 92-97% (n = 124, July 2018-July 2019). PH was defined by echocardiographic evidence of systolic septal flattening or right ventricular pressure ≥35 mmHg (estimated by tricuspid regurgitant jet velocity or shunt velocity) at gestational age (GA) ≥36 weeks. Comparisons between groups were carried out by Chi-square test, t-test, and multivariable logistic regression. Results: Subjects had a GA of 23-32 weeks; 46% were female. Groups did not differ with respect to GA, sex, or birth weight. There was no difference in rate of PH (2.4% vs. 4.2%, p = 0.12) or BPD (25% vs. 20%, p = 0.31) between cohort 1 and cohort 2. Other clinical parameters were not different between groups, including presence of patent ductus arteriosus, presence of atrial septal defect, use of diuretics, or use of steroids. After controlling for GA, birth weight, sex, and diagnosis of BPD using logistic regression, there was no difference in rate of PH between groups (p = 0.47), but there was a positive association of BPD with PH (OR 3.45; 95% CI, 1.18-10.09; p = 0.02). Conclusions: A lower oxygen saturation target was not associated with a higher rate of PH or lower rate of BPD in preterm infants. The overall rate of PH was much lower than rates previously reported at saturation targets <90%. Given our low incidence of PH, and the lack of a significant difference in rate of PH between groups, a saturation target of 92-97% may be safe while also minimizing need for supplemental oxygen in this population.

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CO13 SPLANCHNIC AND CEREBRAL TISSUE OXYGENATION: EFFECTS OF BOLUS AND CONTINUOUS ENTERAL FEEDING EVALUATED BY NEAR INFRARED SPECTROSCOPY IN PRETERM INFANTS

Digestive and Liver Disease ◽

10.1016/s1590-8658(12)60641-0 ◽

2012 ◽

Vol 44 ◽

pp. S246

Author(s):

L. Corvaglia ◽

S. Martini ◽

E. Legnani ◽

B. Battistini ◽

A. Aceti ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Preterm Infants ◽

Near Infrared Spectroscopy ◽

Enteral Feeding ◽

Near Infrared ◽

Tissue Oxygenation ◽

Cerebral Tissue ◽

Cerebral Tissue Oxygenation

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Pilot study of cerebral and somatic autoregulation using NIRS in preterm neonates

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200601 ◽

2021 ◽

pp. 1-8

Author(s):

T.M. Traub ◽

R. Grabowski ◽

K. Rais-Bahrami

Keyword(s):

Pilot Study ◽

Oxygen Saturation ◽

Near Infrared ◽

Arterial Oxygen Saturation ◽

Severity Of Illness ◽

Arterial Oxygen ◽

Tissue Oxygen Saturation ◽

Preterm Neonates ◽

Arterial Access ◽

Arterial Blood

Background: As neonates transition from a relatively hypoxic environment to extra-uterine life, arterial oxygen saturation dramatically increases. This transition occurs while most organs have not fully matured. The ability for immature tissue to adequately extract and utilize oxygen remains largely unknown. With the development of near-infrared spectroscopy (NIRS), measuring specific tissue oxygen saturation (StO2) noninvasively, clinicians can measure StO2 and determine if adequate tissue oxygenation is maintained. The objective of this study is to determine the relationships of NIRS brain and somatic autoregulation function to patients’ severity of illness. Methods: In this prospective cohort pilot study, after parental consent, neonates less than 34 weeks with arterial access, were enrolled. The FORE-SIGHT NIRS probe was placed on the forehead and abdominal wall for 24 hours. Continuous arterial blood pressure, SpO2 and cerebral and somatic NIRS were used to derive autoregulation function. Results: Data was obtained from 17 neonates (0.540 to 2.37 kg, gestation 23.0 to 33.2 weeks). The autoregulation function categorizes pressure passive index (PPI) values as good, borderline, or poor. For normal autoregulation function, PPI values tend to be low and fairly constant for a range of MAP. The PPI borderline zone is a hypothetical range of PPI values where autoregulation function transitions from good to poor. Conclusion: Our results show most premature neonates, as long as they maintained normal BP and systemic circulation can autoregulate cerebral perfusion. When BP are above or below the normal MAP for age, the neonate is at risk for losing brain and somatic autoregulation.

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Meconium and Transitional Stools May Cause Interference with Near-Infrared Spectroscopy Measurements of Intestinal Oxygen Saturation in Preterm Infants

Advances in Experimental Medicine and Biology - Oxygen Transport to Tissue XXXIV ◽

10.1007/978-1-4614-4989-8_40 ◽

2012 ◽

pp. 287-292 ◽

Cited By ~ 5

Author(s):

Alecia Thompson ◽

Paul Benni ◽

Sara Seyhan ◽

Richard Ehrenkranz

Keyword(s):

Infrared Spectroscopy ◽

Oxygen Saturation ◽

Preterm Infants ◽

Near Infrared Spectroscopy ◽

Near Infrared

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Cerebral near-infrared spectroscopy monitoring versus treatment as usual for extremely preterm infants. A protocol for the SafeBoosC randomised clinical phase III trial

10.21203/rs.2.490/v2 ◽

2019 ◽

Author(s):

Mathias Hansen ◽

Adelina Pellicer ◽

Christian Gluud ◽

Eugene Dempsey ◽

Jonathan Mintzer ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Preterm Infants ◽

Near Infrared ◽

Control Group ◽

Severe Brain Injury ◽

Treatment As Usual ◽

Opt Out ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Postmenstrual Age

Abstract Background: Cerebral oxygenation monitoring may reduce the risk of death and neurologic complications in extremely preterm infants, but no such effects have yet been demonstrated in preterm infants in sufficiently powered randomised clinical trials. The objective of the SafeBoosC-III trial is to investigate the benefits and harms of treatment based on near-infrared spectroscopy (NIRS) monitoring compared with treatment as usual for extremely preterm infants. Methods/Design: SafeBoosC III is an investigator-initiated multinational randomised, pragmatic phase III clinical trial. Inclusion criteria will be infants born below 28 weeks postmenstrual age and parental informed consent (unless the site is using ‘opt-out’ or deferred consent). Exclusion criteria will be no parental informed consent (or if ‘opt-out’ is used, lack of record that clinical staff have explained the trial and the ‘opt-out’ consent process to parents and/or a record of parents’ decision to opt-out in the infants clinical file); decision not to provide full life support; and no possibility to initiate cerebral NIRS oximetry within 6 hours after birth. Participants will be randomised 1:1 into either the experimental or control group. Participants in the experimental group will be monitored during the first 72 hours of life with a cerebral NIRS oximeter. Cerebral hypoxia will be treated according to an evidence-based treatment guideline. Participants in the control group will not undergo cerebral oxygenation monitoring and will receive treatment as usual. Each participant will be followed up at 36 weeks postmenstrual age. The primary outcome will be a composite of either death or severe brain injury detected on any of the serial cranial ultrasound scans that are routinely performed in these infants up to 36 weeks postmenstrual age. Severe brain injury will be assessed by a person blinded to group allocation. To detect a 22% relative risk difference between the experimental and control group, we intend to randomise a cohort of 1600 infants. Discussion: Treatment guided by cerebral NIRS oximetry has the potential to decrease the risk of death or survival with severe brain injury in preterm infants. There is an urgent need to assess the clinical effects of NIRS monitoring among preterm neonates. Trial registration: ClinicalTrial.gov NCT03770741 (registered 10/12-2018), https://clinicaltrials.gov/ct2/show/NCT03770741?recrs=b&cond=cerebral+near+infrared+spectroscopy&rank=3

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