Cerebral Oxygenation in Preterm Infants With Germinal Matrix–Intraventricular Hemorrhages

Verhagen, Elise A.; Horst, Hendrik J. ter; Keating, Paul; Martijn, Albert; Braeckel, Koenraad N.J.A. Van; Bos, Arend F.

doi:10.1161/strokeaha.110.597229

Cited by 75 publications

(44 citation statements)

References 34 publications

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“…This could also explain the association between hypoproteinemia and severe neurological injury as both subclinical hypoperfusion and neonatal hypotension are recognized risk factors for cerebral hemorrhage and ischemia in very low BW infants. 20,21 The finding that serum protein levels were lower in infants who died early during hospital stay supports this hypothesis.…”

Section: Discussionmentioning

confidence: 66%

Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

et al. 2011

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Objective: We aimed to investigate the relationship between day-1 hypoproteinemia and severe adverse outcome (SAO) in very preterm infants admitted to the neonatal intensive care unit (NICU).Study Design: Retrospective study of all patients born from 24 to 31 weeks gestation and cared for in our NICU over an 8-year period. Infants were excluded if the serum protein value on the first day of life was not available.Result: A total of 913 patients were included. In all, 14.6% presented with SAO (death or severe neurological injury on cranial ultrasound). Hypoproteinemia (total protein level <40 g l À1 ) on day 1 of life occurred in 19.5 % of all patients. The rate of SAO was 33.7% in patients with hypoproteinemia and 9.9% in those with normoproteinemia (P<0.0001). Logistic and multiple regression analysis confirmed that the association hypoproteinemia-SAO remained significant after adjustment for the other major predictors of outcome present at baseline (odds ratio 3.4; 95% confidence interval 2.1-5.4; P<0.0001).Conclusion: Hypoproteinemia was highly associated with SAO in this cohort of critically ill preterm infants. We are unable to explain the link between hypoproteinemia and adverse outcome in our population. This investigation serves as a hypothesis-generating report of a large preterm infants sample, and suggests the need to assess the predictive accuracy for adverse outcome of hypoproteinemia in future prospective studies.

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Section: Discussionmentioning

confidence: 66%

Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

et al. 2011

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“…Low cerebral blood flow as measured by superior vena cava flow 43,44 or NIRS [14][15][16] in the first days of life is known to be associated with adverse neurological outcome and intraventricular hemorrhage. There are no data, as to whether this applies also during the immediate period of neonatal resuscitation.…”

Section: Brain Oxygenation Monitoring In the Delivery Room H Fuchs Et Almentioning

confidence: 99%

“…It has been used in preterm infants for various healthcare conditions such as respiratory distress syndrome, 7 red blood cell transfusion, 8 desaturations, 9 indomethacin therapy 10,11 or ligation of a patent ductus arteriosus 12,13 and during the critical first days of life. [14][15][16][17] Major determinants of the regional tissue oxygen saturation are changes in SpO 2 , regional perfusion, regional blood volume and metabolic rate of oxygen utilization. 18,19 Cerebral tissue oxygen saturation (cerebral StO 2 ) correlated well with superior vena cava flow and left ventricular cardiac output in preterm infants in the first days of life.…”

Section: Introductionmentioning

confidence: 99%

Brain oxygenation monitoring during neonatal resuscitation of very low birth weight infants

et al. 2011

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Objective: To explore if regional cerebral tissue oxygen saturation monitoring by near-infrared spectroscopy (NIRS) is feasible during neonatal resuscitation of very low birth weight (VLBW) infants after birth.Study Design: Cerebral tissue oxygen saturation was measured by NIRS in 51 VLBW infants (mean gestational age: 27.8 weeks) during the first 10 min after delivery.Result: A regional cerebral tissue oxygen saturation signal was available after a median (interquartile range) age of 52 (44 to 68) s. In three infants the signal was obtained after 10 min of age. After delivery cerebral tissue oxygen saturation rose continuously from 37 (31 to 49) % at 1 minute of age and reached a steady state in the range of 61 to 84% B7 min after birth. Percentiles of cerebral tissue oxygen saturation of this cohort of preterm infants are given. Conclusion:Cerebral tissue oxygen saturation monitoring is feasible during neonatal resuscitation of VLBW infants within the first minutes of life.

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“…Near-infrared spectroscopy (NIRS) has been used to measure regional cerebral tissue oxygen saturation (rcSO 2 ) in term and preterm infants (19,(25)(26)(27)(28)(29)(30). rcSO 2 seems related to both arterial saturation and cerebral blood flow (25,31,32).…”

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confidence: 99%

Cerebral Oxygenation in Very Low Birth Weight Infants Supported With Sustained Lung Inflations After Birth

et al. 2011

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Sustained lung inflations (SIs) immediately after birth might decrease the need for subsequent mechanical ventilation in preterm infants. However, effects of SIs on oxygenation and hemodynamics are undetermined. Our aim was to study immediate effects of SIs on heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation in preterm infants supported with SIs after birth for lung recruitment. Heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation using near infrared spectroscopy was measured in 24 preterm infants of 28.0 (26.6 -29.3) wk GA [median (interquartile range)] during resuscitation using up to three SIs of 20, 25, and 30 cm H 2 O of 15 s duration each followed by nasal continuous positive airway pressure (CPAP) as first line approach for respiratory support. During positioning and suctioning immediately after delivery infants became progressively hypoxemic and bradycardic before respiratory support was initiated. In 18 infants (75%), more than one SI were applied. During the last SIs, there was a rapid increase in the infants' heart rate and an increase in cerebral tissue oxygen saturation. Arterial saturation increased with slight delay. In conclusion, effective last sustained inflations increase heart rate and cerebral tissue oxygen saturation to be followed by an increase in arterial saturation. (Pediatr Res 70: 176-180, 2011) R eplacement of amniotic fluid by air to establish a gaseous functional residual capacity (FRC) is essential for successful transition after birth (1,2). Term and preterm infants begin to breathe after delivery with deep inspirations and braking of expirations (3-7). Closure of the larynx during expiration may help the newborn to maintain FRC (6,8).Clinical and laboratory observations have shown that the application of continuous positive airway pressure (CPAP) helps to establish a gaseous FRC and improve gas exchange (9 -11). In a preterm animal model, the application of SIs of 10 to 20 s duration did further enhance movement of amniotic fluid into the distal airways resulting in an increased FRC and more uniform lung aeration than CPAP alone (10,12).Clinical studies suggest that the use of SIs in preterm infants may help to reduce the need for intubation and mechanical ventilation without adverse effects (13,14). A lower rate of bronchopulmonary dysplasia (BPD) was reported in one study when SIs followed by nasal CPAP was compared with bag and mask ventilation (13). However, these trials have limited power to prove safety of SIs.Possible sequelae of SIs include overdistension of the lung and compromise of hemodynamics as a result of the impaired systemic venous return and decreased pulmonary blood flow caused by the increase in intrathoracic pressure during the procedure (15-18). Cerebral blood flow may be impaired resulting in brain damage in the preterm infant (19 -21). Impaired cerebral venous flow may predispose to intraventricular hemorrhage (IVH) (22) or periventricular hemorrhagic infarction (23,24).Near-infrared spectros...

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Cerebral Oxygenation in Preterm Infants With Germinal Matrix–Intraventricular Hemorrhages

Cited by 75 publications

References 34 publications

Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

Brain oxygenation monitoring during neonatal resuscitation of very low birth weight infants

Cerebral Oxygenation in Very Low Birth Weight Infants Supported With Sustained Lung Inflations After Birth

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