Assessing cerebral blood flow, oxygenation and cytochrome c oxidase stability in preterm infants during the first 3 days after birth

Abstract

A major concern with preterm birth is the risk of neurodevelopmental disability. Poor cerebral circulation leading to periods of hypoxia is believed to play a significant role in the etiology of preterm brain injury, with the first three days of life considered the period when the brain is most vulnerable. This study focused on monitoring cerebral perfusion and metabolism during the first 72 h after birth in preterm infants weighing less than 1500 g. Brain monitoring was performed by combining hyperspectral near-infrared spectroscopy to assess oxygen saturation and the oxidation state of cytochrome c oxidase (oxCCO), with diffuse correlation spectroscopy to monitor cerebral blood flow (CBF). In seven of eight patients, oxCCO remained independent of CBF, indicating adequate oxygen delivery despite any fluctuations in cerebral hemodynamics. In the remaining infant, a significant correlation between CBF and oxCCO was found during the monitoring periods on days 1 and 3. This infant also had the lowest baseline CBF, suggesting the impact of CBF instabilities on metabolism depends on the level of blood supply to the brain. In summary, this study demonstrated for the first time how continuous perfusion and metabolic monitoring can be achieved, opening the possibility to investigate if CBF/oxCCO monitoring could help identify preterm infants at risk of brain injury.

Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children

“…Longitudinal neurometabolic optical monitoring has elucidated risk factors for hypoxic–ischemic brain injury in several pediatric contexts, including during birth transition in healthy and high-risk neonates [ 220 , 234 – 240 ], and during generalized seizures [ 241 , 242 ], cardiac surgery requiring cardiopulmonary bypass [ 213 , 225 , 243 , 244 ], and extracorporeal membrane oxygenation support [ 226 , 245 ]. Quantification of oxygen delivery to the brain intra-arrest [ 246 ] (Fig.…”

Fast estimation of adult cerebral blood content and oxygenation with hyperspectral time-resolved near-infrared spectroscopy

“…Furthermore, the algorithm can be modified to recover other chromophores by increasing the number of chromophores in the fitting parameters and changing the wavelength region of interest to cover the spectral range of the target chromophores. Notably, future work will include adapting the algorithm to monitor the redox state of Cytochrome C Oxidase (CCO), a key biomarker of cerebral oxidative metabolism ( Rajaram et al, 2018 , 2022 ; Lange et al, 2019 ).…”

Diffuse correlation spectroscopy blood flow monitoring for intraventricular hemorrhage vulnerability in extremely low gestational age newborns

“…Previous studies have shown the potential clinical utility of DCS-based CBF analysis in extremely preterm infants, with the reports of distinctive fluctuating patterns in CBF between days 1 and 3 of life 16 and significantly reduced CBF in the presence of low-grade IVH 8 . However, additional research is required to evaluate the clinical utility of DCS monitoring in the context of impaired CAR and IVH vulnerability in ELGA infants.…”