Abstract
BackgroundNon-invasive monitoring of cerebral tissue oxygen saturation (rcSO2) during transition is of growing interest. Different near-infrared spectroscopy (NIRS) techniques have been developed to measure rcSO2. We compared rcSO2 values during the immediate transition in preterm neonates measured with frequency-domain NIRS (FD-NIRS) with those measured with continuous-wave NIRS (CW-NIRS) devices in prospective observational studies.MethodsWe compared rcSO2 values measured with an FD-NIRS device during the first 15 min after birth in neonates with a gestational age ≥ 30 weeks but < 37 weeks born at the Erasmus MC- Sophia Children’s Hospital, Rotterdam, the Netherlands, with similar values measured with a CW-NIRS device in neonates born at the Medical University of Graz, Austria. Mixed models were used to adjust for repeated rcSO2 measurements, with fixed effects for time (non-linear), device, respiratory support and the interaction of device and respiratory support with time. Additionally, parameters such as total haemoglobin concentration and oxygenated and deoxygenated haemoglobin concentrations measured by FD-NIRS were analysed.ResultsThirty-eight FD-NIRS measurements were compared with 58 CW-NIRS measurements. The FD-NIRS rcSO2 values were consistently higher than the CW-NIRS rcSO2 values in the first 12 min, irrespective of respiratory support. After adjustment for respiratory support, the time-dependent trend in rcSO2 differed significantly between techniques (p < 0.01).ConclusionAs cerebral saturation measured with the FD-NIRS device differed significantly from that measured with the CW-NIRS device, differences in absolute values need to be interpreted with care. Although FD-NIRS devices have technical advantages over CW-NIRS devices, FD-NIRS devices may overestimate true cerebral oxygenation and their benefits might not outweigh the usability of the more clinically viable CW-NIRS devices.
Highlights
Non-invasive monitoring of cerebral tissue oxygen saturation during transition is of growing interest
Phase shift To compare the CW-near-infrared spectroscopy (NIRS) device and the frequency-domain NIRS (FD-NIRS) device, we evaluated the effect of the phase shift on the FD-NIRS measurement
To take into account non-linearity in the relation between time and Regional cerebral oxygen saturation (rcSO2), Arterial oxygen saturation (SpO2), total haemoglobin concentration (THb), Oxygenated haemoglobin concentration (O2Hb), and Deoxygenated haemoglobin concentration (HHb), we explored the use of splines and quadratic terms for time
Summary
Non-invasive monitoring of cerebral tissue oxygen saturation (rcSO2) during transition is of growing interest. Regional tissue oxygenation can be continuously monitored with near-infrared spectroscopy (NIRS) The use of this non-invasive technique in neonates allows for the oxygenation but lacks in providing accurate absolute oxygenation estimates [5]. Another NIRS technique, frequency-domain (FD) NIRS, allows for the determination of absolute values of haemoglobin concentration by modulating the intensity of the emitted light by a sinusoidal function. This results in amplitude of modulation (AC), average intensity (DC) and phase-shift (Fig. 1b) measurements, from which the absolute absorption and scattering coefficients are determined. While the CW-NIRS technique has been extensively evaluated in the clinical setting, including the transition after birth [6], bedside FD-NIRS devices are not yet available, and the technique has yet to be evaluated properly in a clinical setting
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