Abstract
The immediate transition from foetus to neonate includes substantial changes, especially concerning the cardiovascular system. Furthermore, the brain is one of the most vulnerable organs to hypoxia during this period. According to current guidelines for postnatal stabilization, the recommended parameters for monitoring are heart rate (HR) and arterial oxygen saturation (SpO2). Recently, there is a growing interest in advanced monitoring of the cardio-circulatory system and the brain to get further objective information about the neonate’s condition during the immediate postnatal transition after birth. The aim of the present study was to combine cardiac output (CO) and brain oxygenation monitoring in term neonates after caesarean section in order to analyse the potential influence of CO on cerebral oxygenation during neonatal transition. This was a monocentric, prospective, observational study. For non-invasive cardiac output measurements, the electrical velocimetry (EV) method (Aesculon Monitor, Osypka Medical, CA, USA) was used. The pulse oximeter probe for SpO2 and HR measurements was placed on the right hand or wrist. The cerebral tissue oxygen index (cTOI) was measured using a NIRO-200NX monitor with the near-infrared spectroscopy (NIRS) transducer on the right frontoparietal head. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, mean CO was calculated from six 10 s periods (with beat-to-beat analysis). During the study period, 99 term neonates were enrolled. Data from neonates with uncomplicated transitions were analysed. CO showed a tendency to decrease until minute 10. During the complete observational period, there was no significant correlation between CO and cTOI. The present study was the first to investigate a possible correlation between CO and cerebral oxygenation in term infants during the immediate neonatal transition. In term infants with uncomplicated neonatal transition after caesarean section, CO did not correlate with cerebral oxygenation.
Highlights
This article is an open access articleTo standardize the assessment of the condition of newborns during the immediate transition period after birth, Virginia Apgar developed a scoring system [1] that is nowadays widely used all over the world
We proved the feasibility of non-invasive cardiac output (CO) measurements in term neonates during neonatal transition in the delivery room using the electrical velocimetry (EV) method [8]
The aim of the present study was to investigate whether there is a significant correlation between non-invasively monitored CO and cerebral oxygenation in term neonates during the neonatal transition period
Summary
This article is an open access articleTo standardize the assessment of the condition of newborns during the immediate transition period after birth, Virginia Apgar developed a scoring system [1] that is nowadays widely used all over the world. Arterial oxygen saturation (SpO2 ) with pulse oximetry and optionally with electrocardiography (ECG) in the delivery room [4]. These monitoring methods do not provide comprehensive information about potentially compromised cardio-circulatory status resulting in compromised oxygen delivery to various organs. Oxygen delivery to the brain depends on the oxygen content of the blood (haemoglobin concentration and oxygen saturation) and cerebral perfusion. Cerebral perfusion depends on cardiac output (CO) and vascular resistance, whereby the evaluation of these cardio-circulatory parameters in the first minutes after birth remains challenging. The aim of the present study was to investigate whether there is a significant correlation between non-invasively monitored CO and cerebral oxygenation in term neonates during the neonatal transition period. We hypothesized that higher CO might be correlated with higher cerebral oxygenation
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