Abstract
One of the most feared neurological complications of premature birth is intraventricular hemorrhage, frequently triggered by fluctuations in cerebral blood flow (CBF). Although several techniques for CBF measurement have been developed, they are not part of clinical routine in neonatal intensive care. A promising tool for monitoring of CBF is its numerical assessment using standard clinical parameters such as mean arterial pressure, carbon dioxide partial pressure (pCO2) and oxygen partial pressure (pO2). A standard blood gas analysis is performed on arterial blood. In neonates, capillary blood is widely used for analysis of blood gas parameters. The purpose of this study was the assessment of differences between arterial and capillary analysis of blood gases and adjustment of the mathematical model for CBF calculation to capillary values. The statistical analysis of pCO2 and pO2 values collected from 254 preterm infants with a gestational age of 23–30 weeks revealed no significant differences between arterial and capillary pCO2 and significantly lower values for capillary pO2. The estimated mean differences between arterial and capillary pO2 of 15.15 mmHg (2.02 kPa) resulted in a significantly higher CBF calculated for capillary pO2 compared to CBF calculated for arterial pO2. Two methods for correction of capillary pO2 were proposed and compared, one based on the mean difference and another one based on a regression model.Conclusion: Capillary blood gas analysis with correction for pO2 as proposed in the present work is an acceptable alternative to arterial sampling for the assessment of CBF.What is Known:• Arterial blood analysis is the gold standard in clinical practice. However, capillary blood is widely used for estimating blood gas parameters.• There is no significant difference between the arterial and capillary pCO2values, but the capillary pO2differs significantly from the arterial one.What is New:• The lower capillary pO2values yield significantly higher values of calculated CBF compared to CBF computed from arterial pO2measurements.• Two correction methods for the adjustment of capillary pO2 to arterial pO2that made the difference in the calculated CBF insignificant have been proposed.
Highlights
One of the primary concerns in the care for preterm born infants is intraventricular hemorrhage (IVH), which may lead to death or permanent disabilities, such as cerebral palsy, learning disabilities, language disorders, blindness, and seizures
Starting from 25 weeks of gestation (WG), capillary measurements in the control group dominated over arterial ones, while a dominance of the cap‐ illary measurements in the affected group was observed for 30 WG only
Statistical analysis of unpaired arterial and cap‐ illary blood measurements revealed that mean values (Fig. 1) significantly differed for Oxygen partial pressure (pO2), but not for Carbon dioxide partial pressure (pCO2) (Table 3)
Summary
One of the primary concerns in the care for preterm born infants is intraventricular hemorrhage (IVH), which may lead to death or permanent disabilities, such as cerebral palsy, learning disabilities, language disorders, blindness, and seizures. Preterm infants are at higher risk for IVH complications depending on their gestational age, weight, and additional risk factors usually occurring during the first 72 h of life until postnatal day seven. IVH typically originates from the highly vascularized area of the germinal matrix [3, 4], which is present until 32 WG [5]. This crucial region for physiological fetal brain development contains numerous glial and neuronal precursor cells migrating to the cortex [3, 6]. Hemorrhages usually happen dur‐ ing the first 72 h of life until postnatal day seven
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