Abstract
Depending on the initial pathology, hypovolemia, intra-abdominal hypertension, and sepsis are often encountered in neonatal digestive surgery. Accurate newborn monitoring during and after surgery is essential to adapt resuscitation protocols. Near infrared spectroscopy (NIRS) is non-invasive and can detect hypoperfusion which indicates a low circulatory blood flow, regardless of the cause. Evaluating changes in cerebral and renal regional oxygen saturation during neonatal digestive surgeries, conducted according to normal practices, with commonly used monitoring parameters. Analyzing retrospectively the inter-relationships between NIRS values and mean arterial pressure (MAP) values as well as pre-ductal SpO2. Prospective, descriptive, monocentric study. All neonates referred for surgery were included. NIRS allows the measurement of cerebral and renal oxygenation fluctuations, as well as calculating difference in intraoperative and postoperative values. Nineteen patients were included. Cerebral regional oxygen saturation (C rSO2) values were stable while renal regional oxygen saturation (R rSO2) values tended to decrease with time during surgery. Indeed, 72% of rSO2 decline episodes occurred after the first 30 min of surgery, without any significant statistical differences for the next 90 min of surgery. After surgery, the lowest average C and R rSO2 values were evidenced during the first 6 h, with 60% of C rSO2 and R rSO2 anomalies occurring in that time frame. There was no significant statistical difference observed in the following 18 h. There was a significant correlation between R rSO2 and SpO2 values (p < 0.01), but not with C rSO2 values. There was no correlation with the MAP either for the C rSO2 values or R rSO2 ones. NIRS is a promising non-invasive bedside tool to monitor cerebral and tissue perfusion, analyzing tissue microcirculation. NIRS has its interest to guide neonatal digestive surgeries (bowel manipulation, viscera reduction) and may represent an early warning for identifying patients requiring resuscitation during or after these surgeries.
Highlights
Neonatal digestive surgery, whether to correct a malformation [gastroschisis, omphalocele, congenital diaphragmatic hernia (CDH), or esophageal atresia (EA)] or an acquired pathology such as necrotizing enterocolitis (NEC) can pose a lifethreatening risk for these children
Ventilation status is documented by pre- or post-ductal pulse oximetry (SpO2 in%), arterial oxygen tension (PaO2 in mmHg), expiratory or peak inspiratory pressure (PIP in cmH2O), fraction of inspired oxygen (FiO2 in%), and measurement of end tidal carbon dioxide measurement (CO2) tension (EtPCO2 in mmHg), via transcutaneous (TcPCO2 in mmHg) or blood (PCO2b in mmHg) measures [4, 5]
Each neonate admitted in the neonatal intensive care unit (NICU), from October 2014 to November 2015, for a surgical digestive procedure was included in the study
Summary
Whether to correct a malformation [gastroschisis, omphalocele, congenital diaphragmatic hernia (CDH), or esophageal atresia (EA)] or an acquired pathology such as necrotizing enterocolitis (NEC) can pose a lifethreatening risk for these children. Whether a consequence of the anesthesia (vasodilatation, hypovolemia, bradycardia), or of the surgery itself (bleeding, loss of bodily fluids, hypothermia), or of related procedures to the initial pathology (reintegration of herniated viscera within the abdomen, sepsis, thoracotomy, and lateral decubitus), a monitoring of the circulatory and ventilatory statuses is mandatory in such cases [1,2,3]. Only systemic measures are available such as fluid volume evaluation and blood flow status. Fluid volume is monitored before, during, and after surgery by direct and indirect mean arterial pressure (MAP in mmHg) and heart rate (HR in beats per min) measurements. Depending on the initial pathology, hypovolemia, intra-abdominal hypertension, and sepsis are often encountered in neonatal digestive surgery. Near infrared spectroscopy (NIRS) is non-invasive and can detect hypoperfusion which indicates a low circulatory blood flow, regardless of the cause
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