Growth restriction and gender influence cerebral oxygenation in preterm neonates

Cohen, Emily; Baerts, W.; Alderliesten, Thomas; Derks, Jan; Lemmers, Petra; Bel, Frank van

doi:10.1136/archdischild-2015-308843

Cited by 38 publications

(39 citation statements)

References 30 publications

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“…In addition, small for gestational age newborns had comparatively higher rSO 2 values than appropriate for gestational age peers. 53 For example, the 10th, 50th, and 90th percentile for rSO 2 in the first 12 hours of life in preterm infants born at 24 to 25 weeks' gestation was 52%, 62%, and 72%, respectively, whereas in preterm infants born at 30 to 31 weeks' gestation, it was 58%, 68%, and 78%, respectively.…”

Section: Individualization Of Oxygen Exposurementioning

confidence: 98%

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

et al. 2017

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John Scott Haldane recognized that the administration of supplemental oxygen required titration in the individual. Although he made this observation in adults, it is equally applicable to the preterm newborn. But how, in practice, can the oxygen requirements in the preterm newborn be determined to avoid the consequences of too little and too much oxygen? Unfortunately, the current generation of oxygen saturation trials in preterm newborns guides saturation thresholds rather than individual oxygen requirements. For this reason, we propose an alternate model for the description of oxygen sufficiency. This model considers the adequacy of oxygen delivery relative to simultaneous consumption. We describe how measuring oxygen extraction or the venous oxygen reservoir could define a physiologically based definition of adequate oxygen. This definition would provide a clinically useful reference value while making irrelevant the absolute values of both oxygen delivery and consumption. Additional trials to test adjunctive, noninvasive measurements of oxygen status in high-risk preterm newborns are needed to minimize the effects of both insufficient and excessive oxygen exposure.

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Section: Individualization Of Oxygen Exposurementioning

confidence: 98%

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

et al. 2017

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“…The IUGR foetus displays typical haemodynamic alterations, including redistribution of its cardiac output to preserve oxygen and nutrient supply to the brain (‘brain sparing') [6]. Our group has previously shown that this brain-sparing effect is postnatally sustained up to 72 h [5,7]. Nevertheless, normalisation - or a trend toward normalisation - of cerebral haemodynamic parameters throughout the first few days of life has also been observed, which could indicate that the cerebral circulatory adaptations following IUGR are transitory [7,16].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, using the Microsoft Excel RAND function, we randomly selected SGA neonates without hsPDA and AGA neonates with/without hsPDA (birth weight 20th to 80th percentile) to serve as control subjects. We have previously shown that gender significantly influences cerebral oxygenation [5,7]. To avoid bias caused by different gender distributions within the groups, the selection of control subjects was performed within the same male-to-female ratio as present in our SGA-hsPDA group.…”

Section: Methodsmentioning

confidence: 99%

“…These data were analysed using a mixed model approach taking into account the individual participant as a random effect nested within the group. Gender and gestational age were included in the model as covariates [5,7]. For cerebral oxygenation data, however, gestational age did not show a significant effect and worsened the model fit, and was thus omitted from these analyses.…”

Section: Methodsmentioning

confidence: 99%

“…This matter is particularly interesting, as our group has previously shown that SGA preterm neonates demonstrate brain sparing-induced elevation of cerebral oxygenation throughout the first days of life [5]. A higher cerebral oxygenation baseline may allow SGA neonates to maintain their cerebral oxygenation at control levels despite the presence of hsPDA [6].…”

Section: Introductionmentioning

confidence: 99%

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Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

Cohen

Dix²,

Baerts³

et al. 2016

Neonatology

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Background: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebral oxygenation than AGA peers throughout the first postnatal days. To date, no studies have investigated the effect of hsPDA on cerebral oxygenation in preterm SGA neonates. Objective: We aimed to assess the effect of hsPDA on cerebral oxygenation in preterm SGA neonates compared to AGA peers. We hypothesised that higher baseline cerebral oxygenation would reduce the impact of hsPDA on cerebral oxygenation in preterm SGA neonates. Methods: We monitored regional cerebral oxygen saturation (rScO₂) with near-infrared spectroscopy and calculated the cerebral fractional tissue oxygen extraction (cFTOE) for 72 h after birth. Retrospective analysis compared 36 preterm SGA neonates (birth weight <10th percentile, 18 with hsPDA) to 36 preterm AGA neonates (birth weight 20th to 80th percentile, 18 with hsPDA). Results: In contrast to the other groups, SGA-hsPDA neonates demonstrated a significant fall in rScO₂ [69% (SEM 2.5) at 4-8 h to 61% (2.7) at 68-72 h, p < 0.001] with a concurrent rise in cFTOE [0.26 (0.026) at 4-8 h to 0.34 (0.030) at 68-72 h, p < 0.001]. Conclusions: Contrary to our hypothesis, hsPDA had a significant negative effect on cerebral oxygenation in preterm SGA neonates. Future studies should explore the potential benefits of early screening and treatment for hsPDA on long-term neurodevelopmental outcome in preterm SGA neonates.

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Preweaning performance in intrauterine growth‐restricted piglets: Characteristics and interventions

Ginneken

Ayuso

Bockstal

et al. 2022

Molecular Reproduction Devel

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Intrauterine growth restriction (IUGR) is frequently observed in pig production, especially when using highly prolific sows. IUGR piglets are born with low body weight and shape indicative of differences in organ growth. Insufficient uteroplacental nutrient transfer to the fetuses is the leading cause of growth restriction in the pig. Supplementing the sow's gestation diet with arginine and/or glutamine improves placenta growth and functionality and consequently is able to reduce IUGR incidence. IUGR piglets are at higher risk of dying preweaning and face higher morbidity than their normal-weight littermates. A high level of surveillance during farrowing and individual nutrient supplementation can reduce the mortality rates.Still, these do not reverse the long-term consequences of IUGR, which are induced by persistent structural deficits in different organs. Dietary interventions periweaning can optimize performance but these are less effective in combating the metabolic changes that occurred in IUGR, which affect reproductive performance later in life. IUGR piglets share many similarities with IUGR infants, such as a poorer outcome of males. Using the IUGR piglet as an animal model to further explore the structural and molecular basis of the long-term consequences of IUGR and the potential sex bias could aid in fully understanding the impact of prenatal undernutrition and finding solutions for both species and sexes.

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Growth restriction and gender influence cerebral oxygenation in preterm neonates

Abstract: Growth restriction and gender influence cerebral oxygenation and oxygen extraction in preterm neonates throughout the first 3 days of life.

Cited by 38 publications

References 30 publications

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

A Theoretical and Practical Approach to Defining “Adequate Oxygenation” in the Preterm Newborn

Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

Preweaning performance in intrauterine growth‐restricted piglets: Characteristics and interventions

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