Cerebral tissue oxygenation index and superior vena cava blood flow in the very low birth weight infant

Moran, Maarit; Miletin, Jan; Pichova, K; Dempsey, Eugene M.

doi:10.1111/j.1651-2227.2008.01006.x

Cited by 54 publications

(39 citation statements)

References 18 publications

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“…It may be helpful to detect a state of low cerebral perfusion and clinical applications so far include cardiac surgery, 25 extracorporeal membrane oxygenation 26,27 and brain injury 28 in more mature infants and children. Applications in preterm infants included cerebral monitoring during the first days of life 7,14,20 or during therapy of a patent ductus arteriosus. 11,13 We tested, if monitoring of cerebral StO 2 is feasible in VLBW infants during neonatal resuscitation during the first minutes after delivery.…”

Section: Discussionmentioning

confidence: 99%

“…If respiratory support was indicated because of low respiratory effort a nasopharyngeal tube was inserted 3 to 4 cm into one nostril and nasal continuous positive airway pressure was applied at 5 cm H 2 O at FiO 2 0.4 using a F120 neonatal ventilator (Stephan, Gackenbach, Germany). If the heart rate remained below 100 bpm or SpO 2 remained <70% without increase, up to three sustained inflations were applied for lung recruitment at increasing pressures (20,25,30 cm H 2 O) for 15 s each, followed by nasopharyngeal intermittent mandatory ventilation or nasal continuous positive airway pressure as described before. 23,24 FiO 2 was adjusted to maintain SpO 2 at 80 to 92%.…”

Section: Neonatal Resuscitationmentioning

confidence: 99%

“…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. 20,21 Therefore, continuous monitoring of cerebral oxygenation may be an ideal tool to detect a state of low cerebraloxygen delivery in preterm infants during neonatal resuscitation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Neonatal Resuscitationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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“…rcSO 2 seems related to both arterial saturation and cerebral blood flow (25,31,32). The aim was to study immediate hemodynamic effects of SIs as measured by heart rate, arterial oxygen saturation (SpO 2 ), and rcSO 2 applied after delivery in very low birth weight (VLBW) infants.…”

mentioning

confidence: 99%

“…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 Metabolism in the Very Low Birth Weight Infant

Dempsey

2011

Handbook of Growth and Growth Monitoring in Health and Disease

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Cerebral tissue oxygenation index and superior vena cava blood flow in the very low birth weight infant

Abstract: There is a positive relationship between cerebral TOI values and SVC flow in the very low birth infant on day one of life.

Cited by 54 publications

References 18 publications

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

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

Cerebral Metabolism in the Very Low Birth Weight Infant

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