DIAGNOSTIC OPPORTUNITIES OF PARA INFRARED SPECTROSCOPY IN FULL-TERM NEWBORNS DURING THERAPEUTIC HYPOTHERMIA IN THE POST ASPHYXIAL PERIOD

Abstract

Introduction. Despite the achievements of neonatology, severe birth asphyxia in full-term infants is still associated with high mortality, long-term neurological morbidity and disability. In the algorithm of managing children with hypoxic-ischemic encephalopathy, it is important to use additional testing methods for early assessment of the severity of brain tissue damage. Assessment of cerebral oxygenation by near-infrared range (near-infrared spectroscopy, NIRS) has strong correlation with MRI brain perfusion in full-term newborns with hypoxic-ischemic encephalopathy. However, recommendations for the use of NIRS monitoring data in neonates with asphyxia and hypoxic-ischemic encephalopathy may differ in routine clinical practice.The objective of the study was to determine the relationship between brain perfusion measurements using NIRS and post asphyxial period characteristics (clinical symptoms, neurosonography, and cerebral artery Doppler ultrasound) in full-term newborns during therapeutic hypothermia.Materials and methods. Full-term infants with severe birth asphyxia who underwent therapeutic hypothermia were examined: 33 infants who had no signs of destructive brain damage, and 15 with destructive hypoxic-ischemic lesions. The results of the NIRS recordings in the post asphyxial period were compared with those of the clinical manifestations and the results of neurosonography and cerebral artery dopplerography.Results. Significant differences (p < 0.05) between observation groups were found regarding the registration of left frontal lobe NIRS: mean rSO2 (p=0.012; 84.01±2.64 % in children with destructive brain lesions) against 76.56±1.71 % in children without destructive lesions); the 25th percentile level of rSO2 (p=0.024, 80.47±2.89 % vs. 72.36±1.75 %, respectively), the 75th percentile of rSO2 (p=0.008, 88.20±2.66 vs. 80.88±1.78). There were no significant differences in the registration of NIRS indicators on the right side. Significant correlation relationships of average strength were recorded between the Galen vein blood flow rate (measurement on the 4th day of life) and the rSO2 average rates on the left (R=0.58), and on the right (R=0.52)Conclusions. Significant differences in the NIRS record scores of children groups with destructive hypoxic-ischemic changes in brain tissue and without destructive changes were observed (Max average rSO2 value on the left during destructive lesions formation). Max average rSO2 values were observed in both left- and right-sided monitoring and were associated with a higher rate of cerebral venous blood flow beyond hypothermia period.