Abstract
Background: Cerebral oxygenation monitored non-invasively by near-infrared spectroscopy (NIRS) is of increasing interest in neonatal care. Cerebral oxygenation is determined by cerebral oxygen delivery and cerebral oxygen consumption. Oxygen delivery as well as oxygen consumption might be influenced by metabolic parameters like blood glucose and lactate.Objective: The aim of the present systematic qualitative review is therefore to identify and summarize all studies, which describe cerebral oxygenation measured with NIRS and blood glucose and/or blood lactate levels in neonates.Data sources: A systematic search of Ovid Embase and PubMed was performed. Search terms included near-infrared spectroscopy, fractional tissue oxygen extraction, cerebral tissue oxygen saturation, regional cerebral tissue oxygen saturation, oxygenation, term, and preterm neonates, cesarean delivery, transition, after-birth, newborn, vaginal delivery, cesarean delivery, baby, neonatal transition, metabolism, lactate, glucose, and blood glucose level.Study selection/data synthesis: Studies analyzing cerebral oxygenation and blood glucose and/or blood lactate levels in neonates were included. Animal studies, duplicates, or studies in non-English language were excluded.Results: Twenty-five studies were identified that describe blood glucose and/or blood lactate levels as primary or secondary outcome parameters with additional measured cerebral oxygenation by NIRS in neonates. Twelve studies were included with blood glucose measurements: four described an association between blood glucose levels and cerebral oxygenation, two show no association, and six do not report on possible associations. Eighteen studies were included with lactate measurements: one describe an association between lactate levels and cerebral oxygenation, while three show no association and 14 do not report on possible associations.Discussion: The influence of blood glucose and blood lactate levels on the cerebral oxygenation in neonates is still controversial. However, there seems to be an association between cerebral oxygenation and the metabolic parameter blood glucose and lactate, which need further investigation.
Highlights
Irreversible cerebral injury due to impaired cerebral oxygenation is a persisting problem in the neonatal period despite improved monitoring and intervention options
A recently published multicenter trial using cerebral near-infrared spectroscopy (NIRS) monitoring to reduce the burden of cerebral hypoxia in preterm neonates described beside cardiovascular and respiratory interventions interventions based on blood glucose levels (5)
The aim of the present systematic qualitative review is to identify and summarize all studies, which describe cerebral oxygenation measured with NIRS and blood glucose and/or blood lactate levels in neonates
Summary
Irreversible cerebral injury due to impaired cerebral oxygenation is a persisting problem in the neonatal period despite improved monitoring and intervention options. A recently published multicenter trial using cerebral NIRS monitoring to reduce the burden of cerebral hypoxia in preterm neonates described beside cardiovascular and respiratory interventions interventions based on blood glucose levels (5). Another recently published study describe an association between blood glucose level and cerebral oxygenation in preterm and term neonates immediately after birth (6). An association between the blood lactate level and the cerebral oxygenation has been described in extremely preterm neonates during the 1st days after birth (7). Cerebral oxygenation monitored non-invasively by near-infrared spectroscopy (NIRS) is of increasing interest in neonatal care. Oxygen delivery as well as oxygen consumption might be influenced by metabolic parameters like blood glucose and lactate
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