Abstract
Current monitoring techniques in neonates lack sensitivity for hypoxia at cellular level. The recent introduction of the non-invasive Cellular Oxygen METabolism (COMET) monitor enables measuring in vivo mitochondrial oxygen tension (mitoPO2), based on oxygen-dependent quenching of delayed fluorescence of 5-aminolevulinic acid (ALA)-enhanced protoporphyrin IX. The aim is to determine the feasibility and safety of non-invasive mitoPO2 monitoring in surgical newborns. MitoPO2 measurements were conducted in a tertiary pediatric center during surgical repair of congenital diaphragmatic hernia or esophageal atresia. Intraoperative mitoPO2 monitoring was performed with a COMET monitor in 11 congenital diaphragmatic hernia and four esophageal atresia neonates with the median age at surgery being 2 days (IQR 1.25–5.75). Measurements were done at the skin and oxygen-dependent delayed fluorescence was measurable after at least 4 h application of an ALA plaster. Pathophysiological disturbances led to perturbations in mitoPO2 and were not observed with standard monitoring modalities. The technique did not cause damage to the skin, and seemed safe in this respect in all patients, and in 12 cases intraoperative monitoring was successfully completed. Some external and potentially preventable factors—the measurement site being exposed to the disinfectant chlorohexidine, purple skin marker, or infrared light—seemed responsible for the inability to detect an adequate delayed fluorescence signal. In conclusion, this is the first study showing it is possible to measure mitoPO2 in neonates and that the cutaneous administration of ALA to neonates in the described situation can be safely applied. Preliminary data suggests that mitoPO2 in neonates responds to perturbations in physiological status.
Highlights
IntroductionMajor (non-cardiac) neonatal surgery is challenging for clinicians
Major neonatal surgery is challenging for clinicians
After obtained informed consent from both parents, measurements were performed during surgical treatment of neonates with congenital diaphragmatic hernia (CDH) or esophageal atresia (EA)
Summary
Major (non-cardiac) neonatal surgery is challenging for clinicians. The anesthesiologist aims to monitor the physiology with the help of the heart rate, invasive blood pressure, saturation, end-tidal carbon dioxide, skin perfusion, urine output, and serum lactate. These broad range of monitoring modalities are used as surrogate of end-organ perfusion with adequate oxygen transport as a prime goal. The optimal blood pressure in neonates for adequate perfusion of peripheral and cerebral tissue is unknown. The incidence of brain injury after (non-cardiac) neonatal surgery is increasingly reported [4, 5] as well as altered long–term neurodevelopmental outcomes [6,7,8,9]. Several factors are thought to contribute to the postoperative brain injury, including alterations in the perioperative neonatal hemodynamics
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