Cerebral Fractional Tissue Oxygen Extraction in Infants with Aortic Coarctation

Abstract

Introduction: infants with aortic coarctation may have altered cerebral perfusion. With Near-infrared Spectroscopy (NIRS), cerebral tissue oxygen extraction (FTOE) is calculated. FTOE reflects cerebral perfusion. Objective: To determine the course of FTOE in the first 48 hours (hrs) of admission in infants with aortic coarctation and to relate this course to short-term outcome. Methods: We included all infants with aortic coarctation and circulatory failure admitted to the NICU of the UMCG in 2009-2010 in whom NIRS-monitoring was performed. Mean values of FTOE were calculated every 12hrs over 2hr-periods. Adverse outcome was defined as need for emergency surgery or death. Results: We included seven infants. Median gestational age was 37.3 weeks (range:31.7-39.6), birth weight: 3340 grams (1345-3910), postnatal age: 10 days (1-18), lactate at admission: 6.7 mmol/l (2.5-19.8). Two infants had an adverse outcome within 36hrs after admission; one needed emergency surgery, one died. infants with adverse outcome showed a high and continuously increasing FTOE over 36hrs while infants with favourable outcome showed a lower and stabilizing FTOE (Table). Conclusion: infants with aortic coarctation show a high FTOE during the first 48hrs of admission, which indicates compromised cerebral perfusion possibly due to circulatory failure. Increasing FTOE over the first 36hrs of admission might indicate adverse short-term outcome. [Course of FTOE in infants with aortic coarctation]