Normal regional tissue oxygen saturation in neonates: a systematic qualitative review

Bruckner, Marlies; Wolfsberger, Christina Helene; Dempsey, Eugene M.; Liem, Kian D.; Lemmers, Petra; Alderliesten, Thomas; Alarcón, Ana; Mintzer, Jonathan; Boode, Willem P. de; Schmölzer, Georg M.; Pichler, Gerhard

doi:10.1038/s41390-021-01786-y

Cited by 13 publications

(12 citation statements)

References 38 publications

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“…Likewise, caution must be exercised in interpreting the clinical relevance of the statistical difference. This is especially in the background of the lack of normative values that allow us to define cerebral and splanchnic hypoxia 11,45,46 …”

Section: Discussionmentioning

confidence: 99%

“…This is especially in the background of the lack of normative values that allow us to define cerebral and splanchnic hypoxia. 11,45,46 As this is an observational study involving PRBCT, it is not possible to distinguish between an increase in oxygenation secondary to PRBCT and the effect of the increase in volume. A randomised controlled study of PRBCT versus saline in such a setting is ethically not permissible.…”

Section: Demographic Featuresmentioning

confidence: 99%

“…More recent studies, including meta-analysis, have evaluated low SCOR as a diagnostic tool for NEC in preterm infants and suggested that decreasing SCOR trends rather than specific cut-off values are more meaningful. [8][9][10] A recent systematic review 11 exploring normative values of regional tissue saturation measured by NIRS indicated that the published values lack quality or adequacy of sample size. It is, therefore, unclear if SCOR can be used for clinical decision-making.…”

Section: Introduction and Objectivesmentioning

confidence: 99%

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Splanchnic‐cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants

Balegar

Jayawardhana

Chazal

et al. 2022

Transfusion Medicine

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Background: Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO 2 s) to simultaneously measured cerebral tissue oxygen (StO 2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT).Aim: The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants.Design: Prospective cohort study.Setting: Neonatal intensive care.Patients: Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume.Interventions: PRBCT at 15 ml/kg, over 4 h.Main Outcome Measures: Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pretransfusion values (SCOR 0, StO 2 s 0, and StO 2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO 2 s 1-28, and StO 2 c 1-28). Dunnett's method was used to adjust for the multiplicity of the p value.Results: Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO 2 c trend, while StO 2 s remained unchanged throughout the study period.

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Section: Discussionmentioning

confidence: 99%

Section: Demographic Featuresmentioning

confidence: 99%

Section: Introduction and Objectivesmentioning

confidence: 99%

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Splanchnic‐cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants

Balegar

Jayawardhana

Chazal

et al. 2022

Transfusion Medicine

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“…Um NIRS in der klinischen Routine nutzen zu können, sind inzwischen neonatale Grenz- und Referenzwerte verfügbar [ 13 ]. Die NIRS kann Bestandteil eines multimodalen Neuromonitoring für kritisch kranke Neugeborene sein, wie z.…”

Section: Nah-infrarot-spektroskopieunclassified

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

Felderhoff-Müser

Hüning

2022

Monatsschr Kinderheilkd

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Das sich entwickelnde Gehirn ist in der Perinatalperiode besonders empfindlich für eine Vielzahl von Insulten, wie z. B. Extremfrühgeburtlichkeit und perinatale Asphyxie. Ihre Komplikationen können zu lebenslangen neurokognitiven, sensorischen und psychosozialen Einschränkungen führen; deren Vorhersage bleibt eine Herausforderung. Eine Schlüsselfunktion kommt der möglichst exakten Identifikation von Hirnläsionen und funktionellen Störungen zu. Die Prädiktion stützt sich auf frühe diagnostische Verfahren und die klinische Erfassung der Meilensteine der Entwicklung. Zur klinischen Diagnostik und zum Neuromonitoring in der Neonatal- und frühen Säuglingsperiode stehen bildgebende Verfahren zur Verfügung. Hierzu zählen zerebrale Sonographie, MRT am errechneten Termin, amplitudenintegriertes (a)EEG und/oder klassisches EEG, Nah-Infrarot-Spektroskopie, General Movements Assessment und die frühe klinische Nachuntersuchung z. B. mithilfe der Hammersmith Neonatal/Infant Neurological Examination. Innovative Biomarker und -muster (Omics) sowie (epi)genetische Prädispositionen sind Gegenstand wissenschaftlicher Untersuchungen. Neben der Erfassung klinischer Risiken kommt psychosozialen Faktoren im Umfeld des Kindes eine entscheidende Rolle zu. Eine möglichst akkurate Prognose ist mit hohem Aufwand verbunden, jedoch zur gezielten Beratung der Familien und der Einleitung von frühen Interventionen, insbesondere vor dem Hintergrund der hohen Plastizität des sich entwickelnden Gehirns, von großer Bedeutung. Diese Übersichtsarbeit fokussiert die Charakterisierung der oben genannten Verfahren und ihrer Kombinationsmöglichkeiten. Zudem wird ein Ausblick gegeben, wie innovative Techniken in Zukunft die Prädiktion der Entwicklung und Nachsorge dieser Kinder vereinfachen können.

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“…Although the measured values of different devices do not display identical numbers, they show a fairly good correlation over time ( 5 ), which enables reliable trend monitoring. Normal ranges for the term and preterm neonates at different time points have been established for many of the used devices, respectively ( 6 – 10 ). Furthermore, different manufacturers use different abbreviations for regional cerebral tissue oxygen saturation, as does the published literature.…”

Section: Introductionmentioning

confidence: 99%

Three Physiological Components That Influence Regional Cerebral Tissue Oxygen Saturation

et al. 2022

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Near-infrared spectroscopy (NIRS) measurement of regional cerebral tissue oxygen saturation (rcStO2) has become a topic of high interest in neonatology. Multiple studies have demonstrated that rcStO2 measurements are feasible in the delivery room during immediate transition and resuscitation as well as after admission to the neonatal intensive care unit. Reference ranges for different gestational ages, modes of delivery, and devices have already been published. RcStO2 reflects a mixed tissue saturation, composed of arterial (A), venous (V), and capillary signals, derived from small vessels within the measurement compartment. The A:V signal ratio fluctuates based on changes in oxygen delivery and oxygen consumption, which enables a reliable trend monitoring of the balance between these two parameters. While the increasing research evidence supports its use, the interpretation of the absolute values of and trends in rcStO2 is still challenging, which halts its routine use in the delivery room and at the bedside. To visualize the influencing factors and improve the understanding of rcStO2 values, we have created a flowchart, which focuses on the three major physiological components that affect rcStO2: oxygen content, circulation, and oxygen extraction. Each of these has its defining parameters, which are discussed in detail in each section.

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Normal regional tissue oxygen saturation in neonates: a systematic qualitative review

Cited by 13 publications

References 38 publications

Splanchnic‐cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants

Splanchnic‐cerebral oxygenation ratio associated with packed red blood cell transfusion in preterm infants

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

Three Physiological Components That Influence Regional Cerebral Tissue Oxygen Saturation

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