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Our results support the idea of focused echocardiography as an additional criterion in the evaluation of outcome in CPR patients and demonstrate its feasibility in the prehospital setting.

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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).

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.

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Background: Oxygen delivery to the brain is dependent on cardiac output and arterial oxygen content. Objectives: The study was designed to investigate the influence of a left-to-right shunt via the ductus arteriosus (DA) on regional oxygen saturation (rSO₂) of the brain and peripheral tissue during postnatal transition. Methods: Nested case-control study. In term neonates after elective cesarian section, rSO₂ of the brain and pre- and postductal peripheral tissue were measured 15 min after uncomplicated postnatal transition. Two groups were formed according to shunt flow characteristics via the DA: shunt group (with a left-to-right shunt), and nonshunt group (no shunt). Results: Of 80 infants, in 58 (72%) a left-to-right shunt was identified, and in 22 (28%) no flow was seen via the DA. The 22 infants formed the nonshunt group. They were matched with 22 newborn infants with a left-to-right shunt via the DA (shunt group). Infants in the nonshunt group had significantly lower cerebral rSO₂ values and higher fractional tissue oxygen extraction and heart rate values. There were no significant differences in regard to peripheral rSO₂ values. Conclusion: During postnatal transition, term infants with a left-to-right shunt via the DA have significantly higher cerebral rSO₂ values compared to infants without shunt flow.

Inflammatory processes with CRP elevation cause impaired peripheral oxygenation and perfusion in neonates even when routine haemodynamic variables are still normal. NIRS might offer a new non-invasive tool for the early recognition and diagnosis of infectious and non-infectious inflammatory processes.