rSo2 and FTOE seem to reflect secondary energy failure. aEEG showed the closest relationship with outcome after severe birth asphyxia.

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Background:Hypothermia is an established therapy in term neonates to reduce death and disability after perinatal asphyxia. Near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rScO 2 ) and amplitude-integrated electroencephalogram (aEEG)-monitored background pattern have been shown to be early predictors of long-term neurodevelopmental outcome. The aim of this study was to investigate the prognostic value of rScO 2 and aEEG for neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. Methods: In neonates with HIE who were subjected to hypothermia, the aEEG background pattern and rScO 2 were studied prospectively from admission up to 84 h in relation to early magnetic resonance imaging and neurodevelopmental outcome at 18 mo of age. results: Of 39 infants, 12 neonates died because of neurological deterioration. One had an adverse outcome and 26 had a favorable outcome. The rScO 2 was higher in neonates with adverse outcome, although aEEG scores were lower. Positive predictive values at 12, 24, and 36 h of age for adverse outcome ranged from 50 to 67% for rScO 2 and aEEG; negative predictive values ranged from 73 to 96% for rScO 2 and 90 to 100% for aEEG. Combining rScO 2 and aEEG increased positive predictive values (70-91%) and negative predictive values (90-100%). conclusion: During hypothermia, rScO 2 and aEEG measurements are early predictors of long-term outcome after HIE. Combining both parameters further improves early prediction.

ArticlesBackground: Currently, reliable reference values of regional cerebral oxygen saturation (rScO 2 ) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO 2 ) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO 2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO 2 − rScO 2 )/SaO 2 ) for small adult and neonatal NIRS sensors. Methods: In this study, 999 infants born preterm (GA <32 wk) were monitored with NIRS during the first 72 h of life. Mixed modeling was used to generate reference curves grouped per 2 wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. results: Average rScO 2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. conclusion: rScO 2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care. d espite advances in neonatal intensive care that have led to a decline in morbidity, preterm birth is still associated with neurological sequelae (1). Brain injury in preterm infants is often caused by disturbances in cerebral blood flow (CBF) and oxygenation (2-4). Evidence is accumulating that monitoring blood pressure alone is not enough to ensure adequate (cerebral) perfusion and oxygenation (5,6).Near-infrared spectroscopy (NIRS) is a technique that can be used to monitor regional cerebral oxygen saturation (rScO 2 ), being both a measure of cerebral oxygenation as well as a surrogate of CBF. NIRS monitoring can be applied for prolonged periods of time, even in the most vulnerable infants (7). It uses multiple wavelengths of NIR light and relies on the distinct absorption spectra of oxygenated (O 2 Hb) and deoxygenated (HHb) hemoglobin to calculate relative concentrations of O 2 Hb and HHb, which are then used to calculate the rScO 2 (O 2 Hb/(O 2 Hb + HHb)). Where pulse-oximetry only measures the oxygen saturation in arterial blood (SaO 2 ), NIRS makes no distinction between different (cerebral) blood volume compartments; therefore, the rScO 2 represents the oxygen saturation in a mixed arterial-capillary-venous compartment in an approximate 20:5:75 distribution (8).NIRS is increasingly being used as a trend monitor of cerebral oxygen supply in neonates admitted to the neonatal intensive care unit (NICU). Readily interpretable reference values could provide another way of using NIRS in neonates by identifying neonates at risk. In other words, to identify neonates whose rScO 2 resides at the outskirts (high or low) of what is considered "normal. " Furthermore, reliable reference values could benefit NIRS research by...

Near-infrared spectroscopy-derived regional tissue oxygen saturation of haemoglobin (rStO₂) reflects venous oxygen saturation. If cerebral metabolism is stable, rStO₂ can be used as an estimate of cerebral oxygen delivery. The SafeBoosC phase II randomised clinical trial hypothesises that the burden of hypo- and hyperoxia can be reduced by the combined use of close monitoring of the cerebral rStO₂ and a treatment guideline to correct deviations in rStO₂ outside a predefined target range. Aims: To describe the rationale for and content of this treatment guideline. Methods: Review of the literature and assessment of the quality of evidence and the grade of recommendation for each of the interventions. Results and Conclusions: A clinical intervention algorithm based on the main determinants of cerebral perfusion-oxygenation changes during the first hours after birth was generated. The treatment guideline is presented to assist neonatologists in making decisions in relation to cerebral oximetry readings in preterm infants within the SafeBoosC phase II randomised clinical trial. The evidence grades were relatively low and the guideline cannot be recommended outside a research setting.

Cerebral oxygenation is not always reflected by systemic arterial oxygenation. Therefore, regional cerebral oxygen saturation (rScO2) monitoring with near-infrared spectroscopy (NIRS) is of added value in neonatal intensive care. rScO2 represents oxygen supply to the brain, while cerebral fractional tissue oxygen extraction, which is the ratio between rScO2 and systemic arterial oxygen saturation, reflects cerebral oxygen utilization. The balance between oxygen supply and utilization provides insight in neonatal cerebral (patho-)physiology. This review highlights the potential and limitations of cerebral oxygenation monitoring with NIRS in the neonatal intensive care unit.

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BACKGROUND AND OBJECTIVES:A hemodynamically significant patent ductus arteriosus (PDA) can compromise perfusion and oxygenation of the preterm brain. Reports suggest that PDA is associated with increased mortality and morbidity. We hypothesize that long-standing low cerebral oxygenation due to PDA might affect brain volume at term equivalent age.