Tissue Oxygenation In Neonates Research Articles

Near-infrared spectroscopy (NIRS) measured tissue oxygenation in neonates with gastroschisis: a pilot study

Background Management of gastroschisis involves either primary or staged closure. Bowel ischemia and abdominal compartment syndrome (ACS) are possible complications that can be related to a method of treatment. NIRS monitoring has never been applied in this group of patients and may allow for earlier detection of complications. Objective To assess near-infrared spectroscopy (NIRS) monitoring in neonates with gastroschisis for detecting changes in tissue oxygenation (rSO2) related to bowel reductions or height of bowel in the silo and for detecting tissue ischemia. Methods Patients with gastroschisis and controls underwent continuous multi-channel assessment of oxygenation of the brain (CrSO2), kidney (RrSO2) and bowel (GrSO2) in a prospective pilot study. Results Fifteen neonates were treated with primary closure (n = 3) or staged closure (n = 12); two had confirmed bowel ischemia, none developed ACS. There was no significant correlation between height of the bowel and GrSO2 at apex (p = .72) or base (p = .54) within the silo. During staged reductions there was a clinically non-significant change in RrSO2 (Δ-2.5%, p = .04), but no significant changes in CrSO2 (p = .11), and GrSO2 of apex (p = .97) and base (p = .31). Patients with confirmed ischemia had GrSO2 that were lower than controls. Conclusions Measuring GrSO2 through a silo is feasible. Staged reduction seems safe based on NIRS measurements, with minimal effect of hydrostatic pressure on bowel oxygenation. NIRS was able to detect subtle changes in intra-abdominal renal perfusion during reduction and could differentiate healthy and ischemic bowel.

Cerebral and peripheral tissue oxygenation in stable neonates: Absent influence of cardiac function.

AimCardiac function is a major factor for tissue perfusion and therefore may affect the tissue oxygen saturation. Aim was to analyse possible associations between cardiac function parameters and cerebral and peripheral tissue oxygenation in neonates on the first day after birth.MethodsFor the present study, we analysed secondary outcome parameters of a previously performed prospective single centre observational study. The prospective study was conducted at the Medical University of Graz, Austria between September 2011 and June 2013. We included preterm and term neonates who were admitted to the neonatal intensive care unit and in whom simultaneous near‐infrared spectroscopy measurements and echocardiography were obtained on the first day after birth. Cardiac function parameters were correlated to cerebral and peripheral tissue oxygen saturation and cerebral and peripheral fractional tissue oxygen extraction at the time of echocardiography.ResultsA total of 60 neonates of whom 47 were preterm and 13 were term (median gestational age: 34; IQR 33‐35 weeks, mean birth weight: 2276 ± 774 grams) were included. There were no statistically significant correlations between cardiac function parameters and regional tissue oxygenation parameters.ConclusionIn the present study, we found no correlation between regional tissue oxygenation and parameters of cardiac function in cardio‐circulatory stable neonates on the first day after birth.

Cerebral Oxygenation in Neonates Immediately after Cesarean Section and Mode of Maternal Anesthesia

Background: Cerebral regional oxygen saturation (crSO₂) during immediate transition and resuscitation immediately after birth is of increasing interest. Objectives: The aim of the present study was to assess whether the type of maternal anesthesia during cesarean section (CS; general anesthesia vs. spinal anesthesia) has an influence on cerebral oxygenation during immediate neonatal transition after birth. Methods: Secondary outcome parameters of prospective observational studies were analyzed. Neonates born by CS from November 2009 to September 2016 at the Medical University of Graz (Austria) were eligible. Term and preterm neonates were included, provided that: (1) crSO₂ was measured by near-infrared spectroscopy, and (2) peripheral arterial oxygen saturation (SpO₂) and heart rate (HR) were measured by pulse oximetry during the first 15 min after birth. Administration of supplemental oxygen was recorded and cerebral fractional tissue oxygen extraction (cFTOE) was calculated out of crSO₂ and SpO₂. For comparison, term and preterm neonates with maternal general anesthesia were matched to neonates with maternal spinal anesthesia during CS. Results: Out of 760 eligible neonates, 64 term (38.8 ± 0.9 weeks of gestation; 32 neonates in each group) and 54 preterm neonates (32.0 ± 2.9 weeks of gestation; 27 neonates in each group) were included. In term neonates, maternal general anesthesia was associated with lower initial SpO₂, HR values, and Apgar scores. The fraction of inspired oxygen (FiO₂) was statistically significantly higher in the general anesthesia group. Nevertheless, crSO₂ and cFTOE did not differ statistically significantly between the groups. In preterm neonates there were no statistically significant differences in SpO₂, HR, crSO₂, and cFTOE between the general and spinal anesthesia groups. Apgar scores at 1 min were statistically significantly lower and FiO₂ was statistically significantly higher in the general anesthesia group. Conclusion: Cerebral tissue oxygenation in neonates during immediate transition after birth was similar after maternal general and spinal anesthesia during CS, despite differences in SpO₂, HR, and supplemental oxygen in term neonates and differences in supplemental oxygen in preterm neonates.

Direct Measurement of Tissue Oxygenation in Neonates via Resonance Raman Spectroscopy: A Pilot Study

Background: The ability to monitor tissue oxygenation in neonates remains a challenge due to limited blood supply and the reliance on invasive procedures. Resonance Raman spectroscopy noninvasively measures tissue oxygenation (RRS-StO₂). Peripheral tissue oxygenation using this novel technology has not been described in neonates. Objectives: To examine the relationship between short-term RRS-StO₂ measurements and central venous saturation (ScvO₂) and pulse oximetry (SpO₂) in preterm and term neonates. Methods: Ninety-seven term neonates had buccal and plantar RRS-StO₂ measurements performed. In 15 preterm neonates, similar measurements were obtained in conjunction with ScvO₂ in the first week of life. Simultaneous SpO₂ and heart rate were also recorded. Results: In healthy neonates, buccal RRS-StO₂ values negatively correlated with the day of life. No correlation existed between buccal and plantar RRS-StO₂ values and ScvO₂ or SpO₂. Greater intra-patient plantar RRS-StO₂ variability was seen in preterm neonates with increasing respiratory support. Conclusions: Neonatal RRS-StO₂ measurements are feasible short term but do not correlate with ScvO₂ and SpO₂. Healthy neonates had greater differences and variability in RRS-StO₂ values, illustrating an evolving microcirculation not detected with pulse oximetry. Greater RRS-StO₂ variability in sick neonates requiring respiratory support may indicate microcirculatory instability despite being within target SpO₂ ranges. Further study is needed to establish if RRS-StO₂ monitoring is an accurate representation of tissue oxygenation.