Preservation of the metabolic rate of oxygen in preterm infants during indomethacin therapy for closure of the ductus arteriosus

Abstract

Background:The aim of this study was to assess and quantify the effects of indomethacin on cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO 2 ) in preterm infants undergoing treatment for a patent ductus arteriosus (PDA). Methods: CBF and CMRO 2 were measured before and after the first dose of a 3-d course of indomethacin to close hemodynamically significant PDA in preterm neonates. Indocyaninegreen (ICG) concentration curves were acquired before and after indomethacin injection to quantify CBF and CMRO 2 . results: Eight preterm neonates (gestational age, 27.6 ± 0.5 wk; birth weight, 992 ± 109 g; 6 males:2 females) were treated at a median age of 4.5 d (range, 4-21 d). Indomethacin resulted in an average CBF decrease of 18% (pre-and post-CBF = 12.9 ± 1.3 and 10.6 ± 0.8 ml/100 g/min, respectively) and an OEF increase of 11% (pre-and post-OEF = 0.38 ± 0.02 and 0.42 ± 0.02, respectively) but no significant change in CMRO 2 (pre-and post-CMRO 2 = 0.83 ± 0.07 and 0.76 ± 0.07 ml O 2 /100 g/min, respectively). Corresponding mean blood pressure (BP), arterial oxygen saturation (S a O 2 ), heart rate, and endtidal carbon dioxide tension levels remained unchanged. conclusion: Indomethacin resulted in significant reduction in CBF but did not alter CMRO 2 because of a compensatory increase in OEF.

Development of a combined broadband near-infrared and diffusion correlation system for monitoring cerebral blood flow and oxidative metabolism in preterm infants

“…Previous studies have shown that infusing indomethacin over relatively short periods (30 min or less) will have measurable effects on cerebral hemodynamic [34,35]. We have previously demonstrated that despite these hemodynamic effects, basal CMRO 2 is maintained, even at this early age, by an increase in cerebral oxygen extraction [27]. The reduction in StO 2 observed in the current study agrees with the concept of a compensatory adjustment in…”

“…The purpose of the current work was twofold: To measure CBF, StO 2 and CMRO 2 in preterm infants diagnosed with patent ductus arteriosus (PDA) who were undergoing treatment with indomethacin. This treatment group was selected because of the well-known vasoconstricting effects of indomethacin, which provides the opportunity to assess if differential spectroscopy can measure the expected decrease in StO 2 required to maintain normal CMRO 2 [27]. CBF was measured before and after indomethacin treatment using ICG as an intravascular contrast agent [23].…”

Evidence of ventricular contamination of the optical signal in preterm neonates with post hemorrhagic ventricle dilation

“…This system has previously been used in a neonatal piglet model [13,14] and neonatal patients at our center. [15] The optical fibers were attached to the head either using a fiber holder headband, or using the CPAP cap to support the fiber holder. We obtained broadband spectra from 600-980 nm at approximately 0.3 nm spectral resolution using a holographic grating coupled to a cooled CCD.…”

Improved light collection and wavelet de-noising enable quantification of cerebral blood flow and oxygen metabolism by a low-cost, off-the-shelf spectrometer

“…9,10 With this technique, the concentrations of tissue chromophores, both endogenous and exogenous, are quantified by first or second differential analyses, which exploit the hyper-spectral content of the measurements. 14 Critical to broadband CW-NIRS monitoring is efficient light collection since only a small fraction of the injected light emerges from the probed tissue due to absorption and strong scattering. [11][12][13] More recently, it has been adapted to clinical studies to investigate potential pharmacological effects on cerebral hemodynamics and metabolism in preterm infants.…”

“…[11][12][13] More recently, it has been adapted to clinical studies to investigate potential pharmacological effects on cerebral hemodynamics and metabolism in preterm infants. 10,[14][15][16] Nevertheless, off-the-shelf spectrometers have attractive advantages compared to custom-made units, such as low cost, small footprint, and wide availability. The most common method for improving light collection is by optimizing the contact area between the detection system and the probed tissue by means of light guides with large detection surface.…”