Cerebral Oxygenation during Different Treatment Strategies for a Patent Ductus Arteriosus

Chock, Valerie Y.; Ramamoorthy, Chandra; Meurs, Krisa P. Van

doi:10.1159/000325149

Cited by 38 publications

(25 citation statements)

References 76 publications

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“…Our results suggest that, in the presence of an echocardiographically determined HSDA, cerebral and renal oxygen delivery is not compromised. Our results are in line with previous studies reporting similar cerebral [9] and renal [10] rSO 2 and FTOE in preterm infants with an HSDA compared with infants with a closed DA. They are also in line with a study reporting similar cerebral and renal rSO 2 and FTOE in infants with large-sized ducts compared with infants with moderate-sized ducts [11].…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies using NIRS to assess organ oxygenation in preterm infants with PDA used different criteria for the determination of an HSDA and found conflicting results concerning the impact of PDA on pre- and postductal organ oxygenation [9,10,11,12]. The specific impact of echocardiographic parameters of hemodynamic significance of a PDA on regional tissue oxygen supply has not been investigated previously.…”

Section: Introductionmentioning

confidence: 99%

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A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Laan¹,

Roofthooft

Fries

et al. 2016

Neonatology

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Background: Patent ductus arteriosus (PDA) is common in preterm infants and is associated with significant morbidity. To determine whether the PDA is hemodynamically significant (HSDA), several echocardiographic parameters have been suggested, including retrograde diastolic blood flow in the descending aorta (Dao). Objective: To assess the impact ofan HSDA, including retrograde diastolic flow in the Dao, on regional tissue oxygen saturation (rSO₂) and extraction measured by near-infrared spectroscopy (NIRS). Methods: This is a prospective observational cohort study in which we included preterm infants (GA <32 weeks) who underwent echocardiographic screening because of clinical signs of an HSDA within 2 weeks after birth. We measured cerebral and renal rSO₂ on the day of echocardiography. HSDA was diagnosed if left-to-right shunting through the PDA was accompanied by left atrial-to-aortic root ratio >1.4 and/or left pulmonary artery end-diastolic flow velocity >0.2 m/s and/or retrograde diastolic blood flow in the Dao. Results: Forty-nine infants were included, with a median GA of 27.6 weeks (IQR: 26.1-29.0), birth weight of 980 g (IQR: 800-1,200), and postnatal age of 77 h (IQR: 70-107). Infants with a closed duct (n = 11), a non-HSDA (n = 18), and an HSDA (n = 20) had similar cerebral and renal NIRS measurements. Retrograde diastolic blood flow in the Dao, present in 11 infants with PDA, also did not affect cerebral and renal NIRS measurements. Conclusion: In preterm infants with clinical signs of an HSDA within 2 weeks after birth, cerebral and renal oxygen saturation and extraction are not affected by an HSDA or by retrograde diastolic blood flow in the Dao.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Laan¹,

Roofthooft

Fries

et al. 2016

Neonatology

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“…Measurement of the cerebral tissue oxygen saturation ( c StO 2 ) by near-infrared spectroscopy (NIRS) allows noninvasive monitoring of oxygen delivery to the brain in preterm and term infants [1,2]. This technique may provide useful information for the prevention of brain damage during transition from fetal to neonatal life [3,4].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Near-Infrared Spectroscopy during Transition of Healthy Term Newborns

et al. 2013

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Background: Values of regional cerebral tissue oxygen saturation (cStO₂) have been described during transition of term and preterm infants after birth. However, use of different devices precludes comparison of measurements. Objective: To measure cStO₂ during transition of term infants using a calibrated 4-wavelength laser light source near-infrared spectroscopy oximeter (FORE-SIGHT) to obtain data that allow comparison with cStO₂ of very-low-birth-weight (VLBW) infants using this oximeter and with cStO₂ of term infants using different oximeters. Methods:cStO₂ (FORE-SIGHT oximeter), preductal arterial oxygen saturation and heart rate were measured in 46 healthy term infants (n = 20 spontaneous delivery, n = 22 caesarean section, n = 4 assisted vaginal delivery) during the first 10 min after delivery. Results: The median (interquartile range) cStO₂ at 2 min after birth was 42% (39-46) after spontaneous delivery, 42% (30-52) after caesarean section and 36% (20-53) after assisted vaginal delivery (no difference between groups). In association with increasing arterial oxygen saturation and heart rate, cStO₂ increased continuously and reached a steady state approximately 8 min after birth of 62-77% (interquartile range) in all three groups. Conclusions: Healthy term newborns had similar cStO₂ changes from 2 min after birth regardless of the mode of delivery. cStO₂ of healthy term infants was lower than cStO₂ of VLBW infants during transition. cStO₂ values as measured by the FORE-SIGHT oximeter seem in the range of values as measured by the NIRO 300 oximeter. They were lower than values as measured by the INVOS 5100 oximeter.

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“…The variable pattern of cerebral blood flow velocity in immature infants with RDS implies a high risk of the development of intracranial hemorrhage [18] . NIRS has been used more recently to assess cerebral oxygenation in preterm newborns [20][21][22] . The ratio of oxygenated hemoglobin to total hemoglobin is measured as the StO 2 of brain tissue [23] .…”

Section: Discussionmentioning

confidence: 99%

Effects of Synchronization during Noninvasive Intermittent Mandatory Ventilation in Preterm Infants with Respiratory Distress Syndrome Immediately after Extubation

Huang¹,

Mendler²,

Waitz³

et al. 2015

Neonatology

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Background: Noninvasive ventilation is increasingly used in very-low-birth-weight infants (VLBWI) to reduce complications that occur with invasive ventilation. However, the physiological effects of synchronization during noninvasive nasal intermittent mandatory ventilation (IMV) have not been tested in VLBWI immediately after extubation. Objective: We aimed to study the short-term effects of synchronized nasal IMV (S-NIMV) compared to nonsynchronized nasal IMV (NIMV) on breathing effort as measured by phasic esophageal pressure (Pe) deflection, spontaneous respiratory rate (RR), gas exchange, cerebral tissue oxygen saturation (StO₂) and intermittent episodes of bradycardia or hypoxemia in VLBWI recovering from respiratory distress syndrome (RDS). Methods: Fourteen VLBWI recovering from RDS were studied using a randomized cross-over design during both S-NIMV and NIMV (of 2 h each) immediately after extubation. Results: Phasic Pe deflection, spontaneous RR and transcutaneous PCO₂ decreased significantly while transcutaneous PO₂ and synchrony rate (defined as peak ventilator pressure delivered within the first half of spontaneous inspiration) increased significantly during S-NIMV compared to during NIMV. There was no difference in blood pressure, average arterial oxygen saturation (SpO₂), cerebral StO₂, fractional tissue oxygen extraction of the brain and severe bradycardia (defined as time with a heart rate <100 beats/min lasting ≥10 s) and in hypoxemic episodes (SpO₂ <80%) between the two modes. Conclusion: Synchronization during nasal ventilation immediately after extubation in VLBWI recovering from RDS improved gas exchange and decreased the respiratory effort, and it could therefore be considered to provide a more efficient respiratory support and synchrony.

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Cerebral Oxygenation during Different Treatment Strategies for a Patent Ductus Arteriosus

Cited by 38 publications

References 76 publications

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Cerebral Near-Infrared Spectroscopy during Transition of Healthy Term Newborns

Effects of Synchronization during Noninvasive Intermittent Mandatory Ventilation in Preterm Infants with Respiratory Distress Syndrome Immediately after Extubation

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