Videomicroscopy as a tool for investigation of the microcirculation in the newborn

Abstract

The perinatal period remains a time of significant risk of death or disability. Increasing evidence suggests that this depends on microcirculatory behavior. Sidestream dark‐field orthogonal polarized light videomicroscopy (OPS) has emerged as a useful assessment of adult microcirculation but the values derived are not delineated for the newborn. We aimed to define these parameters in well term newborn infants. Demographic details were collected prospectively on 42 healthy term neonates (n = 20 females, n = 22 males). OPS videomicroscopy (Microscan) was used to view ear conch skin microcirculation at 6, 24, and 72 h of age. Stored video was analyzed by a masked observer using proprietary software. There were no significant differences between the sexes for any structural parameters at any time point. There was a significant increase over time in small vessel perfusion in female infants only (P = 0.009). A number of 6‐ and 72‐h measurements were significantly correlated, but differed from the 24‐h values. These observations confirm the utility of the ear conch for neonatal microvascular videomicroscopy. They provide a baseline for studies into the use of OPS videomicroscopy in infants. The changes observed are comparable with previous studies of term infants using these and other microvascular techniques. It is recommended that studies for examining the mature neonatal microvascular structure be delayed until 72 h of life, but studies of the physiology of cardiovascular transition should include the 24‐h time point after delivery.

The Sublingual Microcirculation Throughout Neonatal and Pediatric Extracorporeal Membrane Oxygenation Treatment: Is It Altered by Systemic Extracorporeal Support?

“…PVD was lower in pediatric patients than in neonatal patients and in females than in males. This aligns with findings from several observational studies performed in healthy neonates and children, wherein these studies vessel density of cutaneous and buccal microcirculation declined over the first few weeks of life and vessel density of cutaneous microcirculation was lower in females than in males (21–24). Our comparable findings support the accuracy of the technique used, because, despite these being highly complex and critically ill children, the handheld vital microscopy yielded results in which the effect of age and sex on the microcirculation could still be distinguished from the other multiple factors affecting the microcirculation.…”

Assessing the Microcirculation With Handheld Vital Microscopy in Critically Ill Neonates and Children: Evolution of the Technique and Its Potential for Critical Care

“…Also, pressure and movement artifacts are not rare. Although its use is validated in children and neonates, the acquisition is complicated as children need to be sufficiently sedated or fully cooperative to attain good quality imaging (13, 35, 36). Gonzalez et al performed an observational study in the pediatric ICU, where sublingual microcirculatory monitoring was only possible in 17% of the admitted patients in the study period (37).…”

“…Currently, reference values for microcirculatory parameters for neonates and children are lacking. Only two small observational studies have been performed in healthy term neonates and no studies have been performed in healthy children (35, 36). There is insufficient knowledge of intra-individual heterogeneity, the natural fluctuation of measured variables and the correlation between different microvascular beds under healthy and pathological conditions (40).…”

“…The skin of the inner upper arm was the most feasible area; here the skin is thin, without hair and measurements are less prone to movement artifacts caused by breathing. Later on, both SDF imaging and IDF imaging were used on the cutaneous and buccal microcirculation (17, 35, 36). While buccal FVD values were highly reproducible, cutaneous FVD values were not.…”

Videomicroscopic investigation of the microcirculation requires uniform definitions

“…Dear Editor, We would like to compliment Wright et al (2016) for their extensive data which can aid ongoing research in a very important field and like to share a number of important considerations.…”