Evaluation of change of cerebral circulation by SpO<sub>2</sub> in preterm infants with apneic episodes using near infrared spectroscopy

Yamamoto, Akito; Yokoyama, Naoki; Yonetani, Masahiko; Uetani, Yoshiyuki; Nakamura, Hajime; Nakao, Hideto

doi:10.1111/j.1442-200x.2003.01803.x

Cited by 47 publications

(41 citation statements)

References 8 publications

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“…Although some groups have studied the influence of apnea of prematurity on cerebral oxygenation [14,15,16,17,18,19,20,21,22,24,25], only two of them have focused on different types of events [18,22] and neither of the two reported cerebral StO 2 , but instead reported hemoglobin concentrations as a measure of cerebral blood volume. …”

Section: Discussionmentioning

confidence: 99%

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Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

et al. 2014

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Background: Episodes of hypoxemia and bradycardia frequently occur with apnea of prematurity in preterm infants. Little is known about the impact of different event types on the brain. Objectives: To describe the influence of hypoxemia and bradycardia, either isolated or in combination, on cerebral oxygenation. Methods: In 16 preterm infants with intermittent hypoxemia and/or bradycardia, cerebral tissue oxygen saturation (StO₂, as measured by near-infrared spectroscopy), heart rate and pulse oximetric saturation (SpO₂) were recorded simultaneously for 16 h. Events were classified as isolated bradycardia (type 1), isolated hypoxemia (type 2) or combined (simultaneous, type 3; bradycardia first, type 4; hypoxemia first, type 5). Primary outcome was a score representing the area below baseline for cerebral StO₂ desaturation during an event. Secondary outcomes were duration and depth of cerebral desaturation. Results: Patients had a median (range) gestational age of 25.9 (22.6-30.4) weeks and a postnatal age of 32.5 (7-58) days. The median (quartiles) number of events was 49 (34-58). Isolated hypoxemias were the most frequent events (24; 9-36) and isolated bradycardias the least common (0; 0-1). Cerebral StO₂ baseline was not different between event types. Cerebral desaturation score, duration of event and depth of cerebral desaturation were smallest for isolated bradycardias and largest for combined events, especially for those starting with hypoxemia followed by bradycardia. Regardless of event type, 12/16 infants maintained cerebral StO₂ >60% despite severe SpO₂ desaturations. Conclusions: Isolated bradycardias had the lowest impact on cerebral desaturation, and combined events had the highest. Most infants preserved cerebral oxygenation >60% during events.

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Section: Discussionmentioning

confidence: 99%

“…However, little is known about the impact of different event types on cerebral StO 2 . Published studies focused on one type only or did not differentiate between event types [14,15,16,17,18,19,20,21,22]. …”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

et al. 2014

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“…3 b). Other investigators who performed extended periods of rScO 2 monitoring using NIRS reported frequently occurring conditions in preterm infants undergoing critical care as well, leading to reductions in brain oxygenation which might cause ischemic tissue injury if cerebral oxygenation is not readily restored [27,32] .…”

Section: Clinical Applicationsmentioning

confidence: 99%

Monitoring Neonatal Regional Cerebral Oxygen Saturation in Clinical Practice: Value and Pitfalls

Bel

Lemmers

Naulaers³

2008

Neonatology

240

169

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This review focuses on the clinical use of near infrared spectroscopy (NIRS) to assess brain oxygenation by the tissue oxygenation index (TOI), and monitoring regional cerebral oxygen saturation (rScO₂), cerebral fractional tissue oxygen extraction (cFTOE), which is derived from rScO₂, and systemic oxygen saturation. Its precision and pitfalls are discussed. At this stage, it is clear that NIRS-monitored oxygenation of the brain by rScO₂ or TOI lacks the precision required to be used as a robust quantitative variable to monitor cerebral oxygenation. Intra- and especially interpatient variability are too large for this aim. On the other hand, when used merely as a trend monitor in the individual patient, substantial changes in rScO₂ or TOI and consequently of cFTOE, larger than the limits of agreement, can yield important clinical information that suggest an intervention. Since neonatal intensive care is for a substantial part ‘brain orientated’ this approach seems conceivable. This gives rise to the conclusion that NIRS-monitored TOI, rScO₂ and cFTOE increasingly will have a role in clinical practice as semiquantitative indicators of changes in cerebral oxygenation and oxygen extraction. Combination with other (cerebral) parameters such as amplitude-integrated EEG and blood pressure seems promising for further optimization of monitoring the immature brain.

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“…Many research and observational studies were performed with neonates using various types of NIRS/cerebral oximetry monitors. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, no food and drug administration (FDA) approved cerebral oximeter is available for neonates. Successful validation of cerebral oximetry for the FDA has been done in human adult volunteer studies under protocols were jugular bulb and arterial blood samples were obtained under different levels of fractional inspired oxygen (FiO 2 ) levels.…”

Section: Introductionmentioning

confidence: 99%

Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter

2006

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Evaluation of change of cerebral circulation by SpO₂ in preterm infants with apneic episodes using near infrared spectroscopy

Cited by 47 publications

References 8 publications

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Monitoring Neonatal Regional Cerebral Oxygen Saturation in Clinical Practice: Value and Pitfalls

Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter

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Evaluation of change of cerebral circulation by SpO2 in preterm infants with apneic episodes using near infrared spectroscopy

Cited by 47 publications

References 8 publications

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Cerebral Oxygenation during Intermittent Hypoxemia and Bradycardia in Preterm Infants

Monitoring Neonatal Regional Cerebral Oxygen Saturation in Clinical Practice: Value and Pitfalls

Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter

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Evaluation of change of cerebral circulation by SpO₂ in preterm infants with apneic episodes using near infrared spectroscopy