Reference Ranges for Regional Cerebral Tissue Oxygen Saturation and Fractional Oxygen Extraction in Neonates during Immediate Transition after Birth

Pichler, Gerhard; Binder, Corinna; Avian, Alexander; Beckenbach, Elisabeth; Schmölzer, Georg M.; Urlesberger, Berndt

doi:10.1016/j.jpeds.2013.07.007

Cited by 157 publications

(136 citation statements)

References 34 publications

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“…As for neonatal monitoring, the values of cerebral StO 2 for a child and a neonate have been reported to range from 65% to 85% 15 and from 67% to 80%, 16,17 respectively. The oxygen saturation values in this study (75%-78%) were similar to that reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Examiner’s finger-mounted fetal tissue oximetry

Kanayama

Niwayama

2014

J. Biomed. Opt

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Abstract. The best way to assess fetal condition is to observe the oxygen status of the fetus (as well as to assess the condition of infants, children, and adults). Previously, several fetal oximeters have been developed; however, no instrument has been utilized in clinical practice because of the low-capturing rate of the fetal oxygen saturation. To overcome the problem, we developed a doctor's finger-mounted fetal tissue oximeter, whose sensor volume is one hundredth of the conventional one. Additionally, we prepared transparent gloves. The calculation algorithm of the hemoglobin concentration was derived from the light propagation analysis based on the transport theory. We measured neonatal and fetal oxygen saturation (StO 2 ) with the new tissue oximeter. Neonatal StO 2 was measured at any position of the head regardless of amount of hair. Neonatal StO 2 was found to be around 77%. Fetal StO 2 was detected in every position of the fetal head during labor regardless of the presence of labor pain. Fetal StO 2 without labor pain was around 70% in the first stage of labor and around 60% in the second stage of labor. We concluded that our new concept of fetal tissue oximetry would be useful for detecting fetal StO 2 in any condition of the fetus.

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Section: Discussionmentioning

confidence: 99%

Examiner’s finger-mounted fetal tissue oximetry

Kanayama

Niwayama

2014

J. Biomed. Opt

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“…The differences are likely explained by the characteristics of the reported populations (e.g., GA, PA, specific morbidity), duration of measurements, and small sample sizes (9)(10)(11)(17)(18)(19)(20). It seems likely that the rScO 2 will either stabilize or may even increase again after 72 h (12,13,15,21 (15,20,21).It is noteworthy how close the −2 SD bands (i.e., p2.3) are to the rScO 2 threshold (i.e., 33-44%) reported to be associated with functional impairment of the brain (22,23). A lower CBF, either regional or global, in infants with a lower GA is the most plausible explanation for the positive association between GA and rScO 2 .…”

mentioning

confidence: 99%

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

et al. 2015

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ArticlesBackground: Currently, reliable reference values of regional cerebral oxygen saturation (rScO 2 ) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO 2 ) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO 2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO 2 − rScO 2 )/SaO 2 ) for small adult and neonatal NIRS sensors. Methods: In this study, 999 infants born preterm (GA <32 wk) were monitored with NIRS during the first 72 h of life. Mixed modeling was used to generate reference curves grouped per 2 wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. results: Average rScO 2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. conclusion: rScO 2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care. d espite advances in neonatal intensive care that have led to a decline in morbidity, preterm birth is still associated with neurological sequelae (1). Brain injury in preterm infants is often caused by disturbances in cerebral blood flow (CBF) and oxygenation (2-4). Evidence is accumulating that monitoring blood pressure alone is not enough to ensure adequate (cerebral) perfusion and oxygenation (5,6).Near-infrared spectroscopy (NIRS) is a technique that can be used to monitor regional cerebral oxygen saturation (rScO 2 ), being both a measure of cerebral oxygenation as well as a surrogate of CBF. NIRS monitoring can be applied for prolonged periods of time, even in the most vulnerable infants (7). It uses multiple wavelengths of NIR light and relies on the distinct absorption spectra of oxygenated (O 2 Hb) and deoxygenated (HHb) hemoglobin to calculate relative concentrations of O 2 Hb and HHb, which are then used to calculate the rScO 2 (O 2 Hb/(O 2 Hb + HHb)). Where pulse-oximetry only measures the oxygen saturation in arterial blood (SaO 2 ), NIRS makes no distinction between different (cerebral) blood volume compartments; therefore, the rScO 2 represents the oxygen saturation in a mixed arterial-capillary-venous compartment in an approximate 20:5:75 distribution (8).NIRS is increasingly being used as a trend monitor of cerebral oxygen supply in neonates admitted to the neonatal intensive care unit (NICU). Readily interpretable reference values could provide another way of using NIRS in neonates by identifying neonates at risk. In other words, to identify neonates whose rScO 2 resides at the outskirts (high or low) of what is considered "normal. " Furthermore, reliable reference values could benefit NIRS research by...

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“…cStO 2 significantly showed no further changes after 5 min 28 . Pichler et al defined reference ranges and percentile charts for cStO 2 and cFTOE using INVOS TM 5100 (Somanetics, Troy, Michigan, USA) in a large cohort of term and preterm neonates without any need of medical support during the first 15 min after birth, and they found no significant differences comparing term and preterm neonates 29 . The normal reference range of cStO 2 for preterm infants depends on multiple factors such as instrument design, postnatal age, or current clinical status 30 .…”

Section: Reference Rangesmentioning

confidence: 99%

“…They suggested that the frequent periods with possible lack of cerebral autoregulation in RDS infants may cause these infants to be more vulnerable to cerebral damage 46 . Because cerebral oxygenation is essential, cStO 2 monitoring can be an important tool to avoid disturbances between carbon dioxide tensions and impact on complications of this process 29 .…”

Section: Cerebral Oxygenation and Respiratory Distress Syndrome (Rds)mentioning

confidence: 99%

Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates

2017

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Near-infrared spectroscopy (NIRS) is a technology capable of non-invasive, continuous measuring of regional tissue oxygen saturation (StO 2 ). StO 2 represents a state of hemodynamic stability, which is influenced by many factors. Extensive research has been done in the field of measuring StO 2 of various organs. The current clinical availability of several NIRS-based devices reflects an important development in prevention, detection and correction of discrepancy in oxygen delivery to the brain and vital organs. Managing cerebral ischemia remains a significant issue in the neonatal intensive care units (NICU). Cerebral tissue oxygenation (cStO 2 ) and cerebral fractional tissue extraction (cFTOE) are reported in a large number of clinical studies. This review provides a summary of the concept of function, current variability of NIRS-based devices used in neonatology, clinical applications in continuous cStO 2 monitoring, limitations, disadvantages, and the potential of current technology.

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Reference Ranges for Regional Cerebral Tissue Oxygen Saturation and Fractional Oxygen Extraction in Neonates during Immediate Transition after Birth

Cited by 157 publications

References 34 publications

Examiner’s finger-mounted fetal tissue oximetry

Examiner’s finger-mounted fetal tissue oximetry

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates

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