Abstract
Neonatal monitoring in neonatal intensive care is pushing the technological boundaries of newborn brain monitoring in order to improve patient outcome. There is an urgent need of a cot side, real time monitoring for assessment of brain injury severity and neurodevelopmental outcome, in particular for term newborn infants with hypoxic‐ischemic brain injury. This topical review discusses why brain tissue metabolic monitoring is important in this group of infants and introduces the currently used neuromonitoring techniques for metabolic monitoring in the neonatal intensive care unit (NICU). New optical techniques that can monitor changes in brain metabolism together with brain hemodynamics at the cot side are presented. Early studies from these emerging technologies have demonstrated their potential to deliver continuous information regarding cerebral physiological changes in sick newborn infants in real time. The promises of these new tools as well as their potential limitations are discussed.
Highlights
Neuromonitoring and neuroimaging in the hospital has a key importance for therapeutic decisions and appropriate management, this is especially important in neonatal intensive care unit (NICU)
We have demonstrated (a) that relationship of brain oxygenation and cytochrome c oxidase (CCO) during spontaneous desaturation events can be indicative of the severity of the brain injury (Bale et al, 2019) (Figure 5) (b) the association between the brain tissue CCO and systemic physiology fluctuations, represented as ‘metabolic reactivity’, is highly correlated in infants with severe hypoxic ischemic encephalopathy (HIE) (Mitra et al, 2019); and (c) the relationship between oxygenation and metabolism during rewarming after therapeutic hypothermia was depended on the severity of injury (Mitra, Bale, Meek, Uria, et al, 2016)
In a study combining Broadband near infrared spectroscopy (bNIRS) and 31P MRS in 22 piglets we showed that following HI the recovery of oxCCO was correlated with the recovery of nucleotide-triphosphate (NTP)/ total exchangeable phosphate pool and outcome (Bainbridge et al, 2013)
Summary
Neuromonitoring and neuroimaging in the hospital has a key importance for therapeutic decisions and appropriate management, this is especially important in neonatal intensive care unit (NICU). Biomarkers, cerebral metabolism, intensive care medicine, near-infrared spectroscopy, neonatal medicine, optical monitoring Available clinical neuromonitoring solutions in the NICU focus on monitoring brain function using electrical activity (electroencephalography [EEG] with or without amplitude integrated EEG [aEEG]), brain oxygenation (near infrared spectroscopy [NIRS, cerebral oximetry]), and brain structure with cranial ultrasound scan (CrUSS) (Martinello, Hart, Yap, Mitra, & Robertson, 2017).
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