Abstract. Comparability and reproducibility of different near-infrared spectroscopy devices measuring regional tissue oxygen saturation remain poor. Aim of the present study was to compare values and reproducibility of cerebral/peripheral "tissue-oxygenation-index" (TOI; NIRO 300, Hamamatsu R , Japan) with cerebral/peripheral "regional-oxygen-saturation" (rSO; INVOS5100, Somanetics R , USA), and to analyze the influence of quality criteria. Methods: cTOI and crSO2 were measured on the left forehead, pTOI and prSO2 were measured on the left calf. To analyse reproducibility, optodes were reapplied five times. A quality criterion was introduced for cTOI, crSO2 and prSO2. For pTOI quality criteria were introduced in combination with a venous occlusion technique. Results: Cerebral measurements were performed in 37 neonates. cTOI (72.7 + / − 6.2%) was lower than crSO2 (83.3 + / − 5.8%) (p < 0.001). The mean difference between cTOI and crSO2 was 10%. Mean standard deviations of cTOI and crSO2 were similar (cTOI: 4.9 + / − 3.6; crSO2: 4.5 + / − 2.6). Peripheral measurements were performed in 39 neonates. pTOI (66.0 + / − 7.9%) was lower than prSO2 (82.0 + / − 7.0%)(p < 0.001). The mean difference between pTOI and prSO2 was 15%. Mean standard deviations of pTOI (3.7 + / − 2.6%) were lower than of prSO2 (5.0 + / − 3.0%) (p = 0.047). Conclusion: TOI values were significantly lower than rSO2 values, in cerebral and peripheral measurements. Reproducibility was higher for pTOI than for prSO2. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).
BackgroundSince an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.MethodsScores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.ResultsOf 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7 ± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.ConclusionThe Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.Trial registrationclinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0334-7) contains supplementary material, which is available to authorized users.
One of the problems of near-infrared-spectroscopy (NIRS) measurements is low reproducibility. The aim of the present study was to introduce quality criteria to increase reproducibility of peripheral NIRS measurements. In a prospective cohort study in 40 neonates, repeated NIRS measurements were performed on the calf. During five "reapplication" periods (of NIRS optodes), five "measurements" (venous occlusions) were performed. Tissue oxygenation index (TOI), mixed venous oxygenation (SvO2), fractional oxygen extraction (FOE), hemoglobin flow (Hbflow), oxygen delivery (DO2), and oxygen consumption (VO2) were assessed. Measurements with linear changes during venous occlusions were included for further analysis (first quality criterion: R(2)>0.95). The second quality criterion was the equation 0 < or = TOI-SvO2 < or = (SaO2-SvO2)x0.2. Variance components and mean standard deviations were analyzed after introduction of the quality criteria. Variance components of reapplication and measurement decreased after introduction of the second quality criterion (TOI: 46.6-35.0%, SvO2: 76.8-38.2%, FOE: 73.1-37.5%, Hbflow: 70.3-51.9%, DO2: 71.5-52.7%, and VO2: 70.9-63.8%). Mean standard deviations of TOI (6.6+/-3.0 to 4.7+/-3.2%), SvO2 (11.1+/-4.8 to 5.7+/-3.9%), FOE (11.3+/-4.8 to 5.9+/-4.0%), Hbflow (4.3+/-2.0 to 2.9+/-1.6 micromol100 mLmin), and DO2 (17.8+/-7.6 to 11.4+/-6.2 micromol100 mLmin) decreased significantly, too. Only 12% of measurements fulfilled both quality criteria. With the introduction of two quality criteria, test-retest variability of peripheral NIRS measurements decreased significantly and reproducibility increased significantly.
Interpretation of peripheral circulation in ill neonates is crucial but difficult. The aim was to analyse parameters potentially influencing peripheral oxygenation and circulation. In a prospective observational cohort study in 116 cardio-circulatory stable neonates, peripheral muscle near-infrared spectroscopy (NIRS) with venous occlusion was performed. Tissue oxygenation index (TOI), mixed venous oxygenation (SvO(2)), fractional oxygen extraction (FOE), fractional tissue oxygen extraction (FTOE), haemoglobin flow (Hbflow), oxygen delivery (DO(2)), oxygen consumption (VO(2)), and vascular resistance (VR) were assessed. Correlation coefficients between NIRS parameters and demographic parameters (gestational age, birth weight, age, actual weight, diameter of calf, subcutaneous adipose tissue), monitoring parameters (heart rate, arterial oxygen saturation (SaO(2)), mean blood pressure (MAP), core/peripheral temperature, central/peripheral capillary refill time) and laboratory parameters (haemoglobin concentration (Hb-blood), pCO(2)) were calculated. All demographic parameters except for Hbflow and DO(2) correlated with NIRS parameters. Heart rate correlated with TOI, SvO(2), VO(2) and VR. SaO(2) correlated with FOE/FTOE. MAP correlated with Hbflow, DO(2), VO(2) and VR. Core temperature correlated with FTOE. Peripheral temperature correlated with all NIRS parameters except VO(2). Hb-blood correlated with FOE and VR. pCO(2) levels correlated with TOI and SvO(2). The presence of multiple interdependent factors associated with peripheral oxygenation and circulation highlights the difficulty in interpreting NIRS data. Nevertheless, these findings have to be taken into account when analysing peripheral oxygenation and circulation data.
OBJECTIVE -The aim of this study was to measure forearm blood flow (FBF) to detect any possible changes that might indicate vascular disorders in children and adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -FBF was measured by near-infrared spectroscopy (NIRS), venous occlusion at rest, and after handgrip exercise. A total of 40 children and adolescents with type 1 diabetes and 40 healthy children and adolescents (6 -18 years) were matched for age and sex for comparison.RESULTS -In the diabetic group (age 12.79 Ϯ 2.9 years, duration of diabetes 51.5 Ϯ 36 months), FBF at rest was significantly lower (1.39 Ϯ 0.76 ml ⅐ 100 g muscle -1 ⅐ min -1 ) than in control subjects (age 12.66 Ϯ 2.9 years, FBF at rest 1.90 Ϯ 1.19 ml ⅐ 100 g muscle -1 ⅐ min -1 ). After exercise, FBF increased significantly less in the diabetic group (0.70 Ϯ 0.82 ml ⅐ 100 g muscle -1 ⅐ min -1 ) compared with the control subjects (1.15 Ϯ 1.05 ml ⅐ 100 g muscle -1 ⅐ min -1 ). FBF at rest decreased with increasing age in both groups. The change in FBF after exercise was independent of age in the diabetic group and increased with increasing age in control subjects. FBF is reduced with impaired hyperemic response after exercise in children and adolescents with type 1 diabetes.CONCLUSIONS -These data suggest that vascular disorders in childhood are detectable noninvasively by NIRS. Diabetes Care 27:1942-1946, 2004D iabetes is one major risk factor for development of vascular disorders. Vascular disorders described in childhood are microvascular complications of the eye, kidney disorders (low creatinine clearance, fluctuating microproteinuria), or echocardiographic changes (1-4).With near-infrared spectroscopy (NIRS), a relatively new technique, an assessment of skeletal muscle blood flow, especially of the small vessels, is possible and has been validated in several studies (5-9). By means of NIRS, impaired peripheral muscle blood flow and oxygenation has been detected in adult patients with diabetes, peripheral vascular disease, and heart failure (10 -12).No data on muscle blood flow in children and adolescents with type 1 diabetes have been published until now. In the present study, skeletal muscle forearm blood flow (FBF) was measured by means of NIRS in children and adolescents with type 1 diabetes without otherwise clinically detectable microangiopathy and in healthy control subjects. The aim of the present study was to investigate whether muscle blood flow measured by NIRS is already impaired in children and adolescents with type 1 diabetes in the absence of any other clinical signs of vasculopathy. RESEARCH DESIGN ANDMETHODS -Children and adolescents with type 1 diabetes aged 6 -18 years were studied. Patients with microalbuminuria and eye diseases were excluded from the study. Furthermore, patients had to have no evidence of neuropathy, cardiac failure, or intermittent claudication. Both patients with type 1 diabetes and control subjects who were obese or had taken any medication (except insulin) within the last 7 days were exclud...
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