Noninvasive evaluation of splanchnic tissue oxygenation using near-infrared spectroscopy in preterm neonates

Cortez, Josef; Gupta, Meenakshi; Amaram, Arun; Pizzino, Janet; Sawhney, Megha; Sood, Beena G.

doi:10.3109/14767058.2010.511335

Cited by 138 publications

(175 citation statements)

References 23 publications

(37 reference statements)

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“…31 We did not find a decrease in mesenteric tissue oxygenation in infants with moderate PDA on NCPAP, maybe because of the inadequate number of observed cases with moderate PDA on CPAP (n ¼ 2). As recent publications have reported significant variation in mesenteric tissue oxygenation with gestation and/or postpartum age, 32,33 the inclusion of gestation and postpartum age in the regression model has strengthened the results of this study.…”

Section: Discussionsupporting

confidence: 72%

Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus

2011

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Objective: To analyze the levels of regional tissue oxygenation in preterm infants in association with echocardiographically significant patent ductus arteriosis (PDA).Study Design: Preterm infants with gestational age less than 32 week were enrolled before the first dose of the pharmacological treatment for the PDA. Non-invasive near-infrared spectroscopy (NIRS) technology was utilized to measure cerebral (rSO 2 -C), renal (rSO 2 -R) and mesenteric (rSO 2-M ) tissue oxygenation for approximately 60 min. Regional fractional oxygen extraction (FOE) was calculated using simultaneously measured arterial saturation (SaO 2 ). We analyzed regional tissue oxygenation and oxygen extraction, hemodynamic parameters, and demographic and clinical information in association with the size of the PDA (moderate vs large).Result: Among the 38 enrolled infants, the majority were diagnosed with a large (63.2%, n ¼ 24) and the rest with a moderate-sized PDA. Infants with large and moderate PDA were comparable in terms of gestational age, study age and weight, mode of delivery and hemodynamic parameters. A significantly higher proportion of infants with a moderate PDA were mechanically ventilated as compared with those with a large PDA. We found no significant differences in the rSO 2 -C and rSO 2 -R, irrespective of the type of respiratory support. However, in infants with a large PDA on continuous nasal positive airway pressure (NCPAP), the rSO 2 -M was lower and mesenteric FOE was higher than that in mechanically ventilated neonates with a large PDA, and in those with moderate PDA irrespective of the type of respiratory support. Conclusion:The PDA size did not affect cerebral and renal tissue oxygenation, but the mesenteric tissue oxygenation was decreased in infants with a large PDA on NCPAP.

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Section: Discussionsupporting

confidence: 72%

Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus

2011

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“…Our preliminary findings suggest that splanchnic tissue oxygenation is differently affected by the two enteral feeding modalities. Reduced splanchnic oxygenation has been proposed to be a predictive marker of feeding intolerance, sepsis (26), splanchnic ischemia (15), and necrotizing enterocolitis (14) in preterm infants. Considering this evidence, the response of splanchnic tissue oxygenation to continuous feeding needs to be carefully evaluated in larger studies focusing specifically on potential consequences related to feeding tolerance.…”

Section: Articlesmentioning

confidence: 99%

Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants

et al. 2014

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Background: Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However, there is no clear evidence regarding which method is better tolerated. We investigated the differences between bolus and continuous feeding in terms of cerebral and splanchnic oxygenation in healthy preterm infants. Methods: Thirty preterm infants underwent a simultaneous 6-h near-infrared-spectroscopy monitoring of cerebral and splanchnic oxygenation, during which they were fed twice through an orogastric tube: one meal was given as a 10-min bolus, and the other was given continuously over a period of 3 h. Oxygenation trends over time were evaluated and compared between bolus and continuous feeding modes. results: Cerebral oxygenation did not change over time and did not differ between the two feeding techniques. Splanchnic oxygenation changed significantly over time and differed between the two feeding techniques, with a significant increase after bolus feeding and a remarkable reduction during continuous feeding. conclusion: Bolus and continuous feeding modes influence splanchnic oxygenation in healthy preterm infants differently. Further studies are needed to investigate possible underlying mechanisms and potential effects on feeding tolerance.n eonatal care has substantially improved over the past decades, leading to a significant increase in the survival rate of very preterm infants (1). Enteral nutrition is essential for the development of the gastrointestinal tract in the preterm population because it improves intestinal motor activity (2), enhances the release of gastrointestinal hormones with trophic effects (3), and ameliorates feeding tolerance (4). However, very preterm infants are unable to coordinate sucking, swallowing, and breathing (5); thus, they are usually fed via an intragastric tube, continuously or through intermittent boluses (6). Differences between continuous and bolus tube feeding in terms of weight gain, days to full enteral feeding achievement, feeding tolerance, and effect on necrotizing enterocolitis have been largely investigated. Currently, however, there is no clear evidence regarding the method that is better tolerated (7). The effect of the two feeding techniques on cerebral and splanchnic oxygenation has not been extensively investigated. Regional tissue oxygenation results from a dynamic balance between oxygen supply and consumption; thus, a reduction in this parameter might reflect an impairment of systemic oxygen saturation (e.g., due to the occurrence of apneic episodes (8)), a decreased cardiac output leading to a reduction of peripheral perfusion (9), a hemodynamic variation within the examined tissue (e.g., regional vasoconstriction/vasodilatation), or a higher oxygen consumption required to satisfy the metabolic demand (10).Near-infrared spectroscopy (NIRS) is a noninvasive technique based on the near-infrared light absorption spectra of cytochromes, which provides a continuous monitoring of regional tissue oxygenation by measuring the levels of oxygenated a...

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“…While some NIRS sensors, designed to measure cerebral, renal, and splanchnic tissue oxygenation, are convenient, others are cumbersome when applied to a neonate, making prolonged monitoring challenging [7,8,9,10]. Additionally, the NIRS spectra of myoglobin are indistinguishable from that of oxy- and deoxyhemoglobin, which might account for the majority of the NIRS signal based on proton magnetic resonance data [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Direct Measurement of Tissue Oxygenation in Neonates via Resonance Raman Spectroscopy: A Pilot Study

Iyengar

Gaillardetz²,

Tighiouart³

et al. 2017

Neonatology

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Background: The ability to monitor tissue oxygenation in neonates remains a challenge due to limited blood supply and the reliance on invasive procedures. Resonance Raman spectroscopy noninvasively measures tissue oxygenation (RRS-StO₂). Peripheral tissue oxygenation using this novel technology has not been described in neonates. Objectives: To examine the relationship between short-term RRS-StO₂ measurements and central venous saturation (ScvO₂) and pulse oximetry (SpO₂) in preterm and term neonates. Methods: Ninety-seven term neonates had buccal and plantar RRS-StO₂ measurements performed. In 15 preterm neonates, similar measurements were obtained in conjunction with ScvO₂ in the first week of life. Simultaneous SpO₂ and heart rate were also recorded. Results: In healthy neonates, buccal RRS-StO₂ values negatively correlated with the day of life. No correlation existed between buccal and plantar RRS-StO₂ values and ScvO₂ or SpO₂. Greater intra-patient plantar RRS-StO₂ variability was seen in preterm neonates with increasing respiratory support. Conclusions: Neonatal RRS-StO₂ measurements are feasible short term but do not correlate with ScvO₂ and SpO₂. Healthy neonates had greater differences and variability in RRS-StO₂ values, illustrating an evolving microcirculation not detected with pulse oximetry. Greater RRS-StO₂ variability in sick neonates requiring respiratory support may indicate microcirculatory instability despite being within target SpO₂ ranges. Further study is needed to establish if RRS-StO₂ monitoring is an accurate representation of tissue oxygenation.

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Noninvasive evaluation of splanchnic tissue oxygenation using near-infrared spectroscopy in preterm neonates

Abstract: We have reported feasibility, safety and ranges for rsSO₂ for a small number of preterm infants in the first 2 weeks of life.

Cited by 138 publications

References 23 publications

Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus

Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus

Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants

Direct Measurement of Tissue Oxygenation in Neonates via Resonance Raman Spectroscopy: A Pilot Study

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