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Wirayannawat W, Amawat J, Yamsiri N, Paes B, Kitsommart R. Comparison of the SenSmart™ and the INVOS™ neonatal cerebral near-infrared spectrometry devices. Front Pediatr 2023; 11:1243977. [PMID: 37691777 PMCID: PMC10485771 DOI: 10.3389/fped.2023.1243977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives To determine the correlation and agreement between the SenSmart™ and the INVOS™ devices of neonatal cerebral regional oxygen saturation (CrSO2) measurements using neonatal sensors. The secondary objective was to develop a regression model that predicts CrSO2-INVOS values using CrSO2-SenSmart indices and determine whether the values between the devices are interchangeable. Methods A prospective, cross-sectional study was conducted in infants during the first 4 weeks of life. Simultaneous, bilateral CrSO2 was measured using the SenSmart™X100 (CrSO2-SenSmart) or INVOS™ 5100C (CrSO2-INVOS) device in each frontoparietal area for 2 h. Five-minute CrSO2 values were extracted for analysis. Results Thirty infants were recruited with 720 pairwise measurements and 26 (84%) were evaluated in the first week of life. Mean gestational age of the preterm and term infants was [30.9 ± 2.8 (n = 14) and 38.8 ± 1.1 (n = 16)] weeks, respectively. Overall CrSO2- was 77.08 ± 9.70% and 71.45 ± 12.74% for the SenSmart and INVOS, respectively (p < 0.001). The correlation coefficient (r) between the CrSO2-SenSmart and INVOS was 0.20 (p < 0.001). The mean difference between the CrSO2-SenSmart and INVOS was 5.63 ± 13.87% with -21.6% to 32.8% limits of agreement. The r and mean difference was 0.39 (p < 0.001) and 8.87 ± 12.58% in preterm infants, and 0.06 (p = 0.27) and 2.79 ± 14.34 in term infants. Conclusion The CrSO2-SenSmart tended to read higher than the CrSO2-INVOS device. There was no correlation between the CrSO2-SenSmart and the CrSO2-INVOS in term infants and it was weak in preterms. Due to imprecise agreement, the CrSO2-SenSmart values are not interchangeable with those of the CrSO2-INVOS.
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Affiliation(s)
- Wariphan Wirayannawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jutharat Amawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattaya Yamsiri
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Katheria AC, Law BHY, Poeltler D, Rich W, Ines F, Schmölzer GM, Lakshminrusimha S. Cardiac and cerebral hemodynamics with umbilical cord milking compared with early cord clamping: A randomized cluster crossover trial. Early Hum Dev 2023; 177-178:105728. [PMID: 36827750 PMCID: PMC10034920 DOI: 10.1016/j.earlhumdev.2023.105728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE A large, randomized cluster cross-over trial (N = 1730) comparing intact umbilical cord milking (UCM) to early cord clamping (ECC) in non-vigorous near-term/term newborns demonstrated a reduction in cardiorespiratory interventions at birth and less moderate to severe hypoxic ischemic encephalopathy. We evaluated changes in cerebral tissue oxygenation (StO2), pulse oximetry (SpO2), pulse rate and fraction of inspired oxygen (FiO2) during the first 10 min of life in a subset of infants enrolled in the parent trial. STUDY DESIGN Infants enrolled in the Milking in Non-Vigorous Infants trial that had StO2 monitoring at birth were included in the sub-study conducted at 3 hospitals the US and Canada. A near-infrared spectroscopy sensor, pulse oximeter and electrocardiogram electrodes were placed. Pulse rate, StO2, SpO2, and FiO2 were collected for the first 10 min after birth. Longitudinal models were used to compare effects of UCM and ECC. RESULTS Thirty-four infants had StO2 data. Fifteen of these infants received UCM and 19 had ECC. Infants receiving UCM had similar heart rates, SpO2, and StO2 values, but were exposed to less FiO2 over the first 10 min of life than infants with ECC (0.26 ± 0.12 vs. 0.81 ± 0.05 at 10 min). CONCLUSION Non-vigorous term/near term infants who received UCM at birth required lower FiO2 after delivery when compared to infants who umbilical cords were clamped soon after birth while achieving similar peripheral and cerebral oxygenation. Cord milking may be a potential option for placental transfusion in non-vigorous near term/term infants when delayed cord clamping cannot be performed.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States.
| | | | - Debra Poeltler
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Felix Ines
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | | | - Satyan Lakshminrusimha
- Department of Pediatrics, University of California Davis Children's Hospital, Sacramento, CA, United States
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3
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Akın MŞ, Sarı FN, Ceran B, Bozkaya D, Okman E, Alkan M, Dizdar EA. Cerebral monitoring of very preterm infants with anterior cerebral artery resistive index and early NIRS. Turk J Med Sci 2023; 53:225-232. [PMID: 36945950 PMCID: PMC10388066 DOI: 10.55730/1300-0144.5577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/10/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The prediction of adverse conditions in the preterm neonatal brain might be improved by cerebral monitoring using combined measures of cerebral function, including oxygenation and blood flow parameters. To perform the consecutive measurements of the resistive index (RI) from the anterior cerebral artery (ACA) within the first week of life and to evaluate the association of these measurements with cerebral oxygen saturation (Csat) detected by near-infrared spectroscopy (NIRS). METHODS This prospective cohort study enrolled very preterm infants, <32 weeks of gestational age, admitted to a tertiary neonatal intensive care unit. Csat levels were continuously monitored using NIRS for 72 h after birth. ACA RI measurements were obtained on the first, third, and seventh days of life by using transcranial Doppler ultrasound. These measurements were also compared between infants with and without unfavorable outcomes, including severe intraventricular hemorrhage (IVH) and early mortality. RESULTS A total of 96 preterm infants with Csat and ACA RI measurements were analyzed. Age at birth was 28.3 ± 1.9 weeks and birth weight was 1090 ± 305 g. The mean Csat of the infants was 77.1% ± 8.2% during the first 72 h of life. Mean ACA RI values were 0.76 ± 0.10, 0.75 ± 0.08, and 0.77 ± 0.08 on the first, third, and seventh days of life, respectively. RI on the first day of life was significantly higher in infants delivered by cesarian section than in those delivered vaginally (0.77 vs. 0.69; p = 0.017). Infants who died earlier had significantly higher ACA RI values on the first day than infants who survived beyond the first 7 postnatal days (0.83 vs. 0.76; p < 0.001). DISCUSSION There was no association between ACA RI and Csat in the early period of life. ACA RI values on the first postnatal day might be significant for predicting early mortality in very preterm infants.
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Affiliation(s)
- Mustafa Şenol Akın
- Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Fatma Nur Sarı
- Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Burak Ceran
- Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Davut Bozkaya
- Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Esin Okman
- Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Mihriban Alkan
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | - Evrim Alyamaç Dizdar
- Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
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4
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Bailey SM, Prakash SS, Verma S, Desai P, Kazmi S, Mally PV. Near-infrared spectroscopy in the medical management of infants. Curr Probl Pediatr Adolesc Health Care 2022; 52:101291. [PMID: 36404215 DOI: 10.1016/j.cppeds.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016.
| | - Shrawani Soorneela Prakash
- Division of Neonatology, Department of Pediatrics, NYCHHC/Lincoln Medical and Mental Health Center, Bronx, NY 10451
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Purnahamsi Desai
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Sadaf Kazmi
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
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5
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El-Dib M, Munster C, Sunwoo J, Cherkerzian S, Lee S, Hildrey E, Steele T, Bell K, Franceschini MA, Volpe JJ, Inder T. Association of early cerebral oxygen saturation and brain injury in extremely preterm infants. J Perinatol 2022; 42:1385-1391. [PMID: 35790852 PMCID: PMC11262415 DOI: 10.1038/s41372-022-01447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the association between cerebral saturation (crSO2) using Near-Infrared Spectroscopy (NIRS) and brain injury in extremely preterm infants. STUDY DESIGN This retrospective study includes 62 infants (<28 weeks gestation) who underwent continuous NIRS monitoring in the first 5 days after birth. Median crSO2 were compared in 12 h increments between infants with and without germinal matrix/intraventricular hemorrhage (GM/IVH). crSO2 was also compared by IVH severity, onset, and by grade of injury on term equivalent MRI. RESULTS After 48 h of life (HOL), infants with GM/IVH had significantly lower crSO2 than those without GM/IVH in analysis adjusted for potential confounding e.g., at 49-60 HOL (69.5 (66.2, 72.8) vs. 74.7 (71.8, 77.6), p = 0.023). There were no significant differences in crSO2 by IVH subcategory or injury severity on MRI. CONCLUSION Clinical use of NIRS has the potential to identify crSO2 patterns associated with development of GM/IVH.
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Affiliation(s)
- Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Chelsea Munster
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John Sunwoo
- Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily Hildrey
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tina Steele
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine Bell
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria Angela Franceschini
- Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph J Volpe
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, USA
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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6
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Surak A, Lalitha R, Bitar E, Hyderi A, Hicks M, Cheung PY, Kumaran K. Multimodal Assessment of Systemic Blood Flow in Infants. Neoreviews 2022; 23:e486-e496. [PMID: 35773505 DOI: 10.1542/neo.23-7-e486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The assessment of systemic blood flow is a complex and comprehensive process with clinical, laboratory, and technological components. Despite recent advancements in technology, there is no perfect bedside tool to quantify systemic blood flow in infants that can be used for clinical decision making. Each option has its own merits and limitations, and evidence on the reliability of these physiology-based assessment processes is evolving. This article provides an extensive review of the interpretation and limitations of methods to assess systemic blood flow in infants, highlighting the importance of a comprehensive and multimodal approach in this population.
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Affiliation(s)
- Aimann Surak
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Renjini Lalitha
- Division of Neonatology, London Health Sciences Centre, London, ON, Canada
| | - Eyad Bitar
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Abbas Hyderi
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Matt Hicks
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Po Yin Cheung
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada.,Department of Pharmacology and Surgery, University of Alberta, Edmonton, AB, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Edmonton, AB, Canada
| | - Kumar Kumaran
- Division of Neonatology, Stollery Children's Hospital, Edmonton, AB, Canada
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7
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Katheria AC, Allman P, Szychowski JM, Essers J, Carlo WA, Schmölzer GM, Dempsey E, Yanowitz T, Kaempf J, Vora F, Bhat S, Arnell K, Rich W, Varner M. Perinatal Outcomes of Subjects Enrolled in a Multicenter Trial with a Waiver of Antenatal Consent. Am J Perinatol 2022; 39:904-908. [PMID: 33142340 PMCID: PMC8788902 DOI: 10.1055/s-0040-1719184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to determine whether outcomes differed between infants enrolled in the PREMOD2 trial and those otherwise eligible but not enrolled, and whether the use of waiver effected these differences. STUDY DESIGN The multicenter PREMOD2 (PREmature infants receiving Milking Or Delayed cord clamping) trial was approved for waiver of antenatal consent by six of the nine sites institutional review boards, while three sites exclusively used antenatal consent. Every randomized subject delivered at a site with a waiver of consent was approached for postnatal consent to allow for data collection. Four of those six sites IRBs required the study team to attempt antenatal consent when possible. Three sites exclusively used antenatal consent. RESULTS Enrolled subjects had higher Apgar scores, less use of positive pressure ventilation, a lower rate of bronchopulmonary dysplasia, and a less frequent occurrence of the combined outcome of severe intraventricular hemorrhage or death. A significantly greater number of infants were enrolled at sites with an option of waiver of consent (66 vs. 26%, risk ratio = 2.54, p < 0.001). At sites with an option of either approaching families before delivery or after delivery with a waiver of antenatal consent, those approached prior to delivery refused consent 40% (range 15-74% across six sites) of the time. CONCLUSION PREMOD2 trial demonstrated analytical validity limitations because of the variable mix of antenatal consent and waiver of consent. A waiver of antenatal consent for minimal risk interventional trials conducted during the intrapartum period will be more successful in enrolling a representative sample of low and high-risk infants if investigators are able to enroll all eligible subjects. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03019367. KEY POINTS · Waiver of consent is when informed consent cannot be obtained prior to delivery.. · Cord milking is a procedure in which blood is pushed (stripped) two to four times towards the newborn.. · Delayed clamping means the umbilical cord is not clamped immediately after birth..
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Affiliation(s)
- Anup C. Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Phillip Allman
- Department of Biostatistics, The UAB School of Public Health, Birmingham, Alabama
| | - Jeff M. Szychowski
- Department of Biostatistics, The UAB School of Public Health, Birmingham, Alabama
| | - Jochen Essers
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama, Birmingham, Alabama
| | - Georg M. Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Eugene Dempsey
- Department of Paediatrics and INFANT Centre, University College Cork, Cork, Ireland
| | - Toby Yanowitz
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph Kaempf
- Women and Children’s Services, Providence St. Vincent Medical Center, Portland, Oregon
| | - Farha Vora
- Department of Pediatrics, Loma Linda University, Loma Linda, California
| | - Shazia Bhat
- Department of Pediatrics, ChristianaCare Health System, Newark, Delaware
| | - Kathy Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
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Variane GFT, Camargo JPV, Rodrigues DP, Magalhães M, Mimica MJ. Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care. Front Pediatr 2022; 9:755144. [PMID: 35402367 PMCID: PMC8984110 DOI: 10.3389/fped.2021.755144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Division of Neonatology, Grupo Santa Joana, São Paulo, Brazil
| | - João Paulo Vasques Camargo
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Data Science Department, OPD Team, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maurício Magalhães
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Jenné Mimica
- Department of Pathology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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9
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Cerebral saturation reflects anterior cerebral artery flow parameters by Doppler ultrasound in the extremely premature newborn. J Perinatol 2022; 42:237-242. [PMID: 34247188 DOI: 10.1038/s41372-021-01145-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/30/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Near-infrared spectroscopy measures cerebral saturation (Csat), although correlation with cerebral blood flow remains unclear in premature newborns at risk for intraventricular hemorrhage (IVH). OBJECTIVES Compare Doppler markers of anterior cerebral artery (ACA) flow with Csat obtained during head ultrasound (HUS). METHOD Newborns <29 weeks (2013-2017) underwent Csat monitoring with clinical acquisition of HUS. ACA Doppler markers were measured (with and without pressure) and Resistive Index (RI) was calculated. Mixed effects models evaluated the association between Csat and Doppler markers. RESULTS 98 neonates with 175 Csat-HUS observations were analyzed. Age at birth was 26.2 ± 1.5 weeks, with post-menstrual age of 26.9 ± 1.7 weeks at HUS. Csat was associated with RI without pressure (p = 0.045), RI with pressure (p = 0.019), and peak systolic velocity with pressure (p = 0.036). Severe IVH (n = 27 [15%]) was associated with lower Csat (60 ± 11% vs 68 ± 9%, p = 0.01). CONCLUSION Csat was associated with ACA Doppler measurements in extremely premature neonates.
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10
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Schwab AL, Mayer B, Bassler D, Hummler HD, Fuchs HW, Bryant MB. Cerebral Oxygenation in Preterm Infants Developing Cerebral Lesions. Front Pediatr 2022; 10:809248. [PMID: 35498781 PMCID: PMC9039301 DOI: 10.3389/fped.2022.809248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated the association between cerebral tissue oxygen saturation (cStO2) measured by near-infrared spectroscopy (NIRS) and cerebral lesions including intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). METHODS Preterm infants <1,500 g received continuous cStO2 monitoring, initiated at the earliest time possible and recorded until 72 h of life. Mean cStO2 over periods of 5, 15, 30 min and 1 h were calculated. To calculate the burden of cerebral hypoxia, we defined a moving threshold based on the 10th percentile of cStO2 of healthy study participants and calculated the area under the threshold (AUT). cStO2 <60% for >5 min was regarded a critical event. The study was registered on clinicaltrials.gov (ID NCT01430728, URL: https://clinicaltrials.gov/ct2/show/NCT01430728?id=NCT01430728&draw=2&rank=1). RESULTS Of 162 infants (gestational age: mean 27.2 weeks, standard deviation 20 days; birth weight: mean 852 g, standard deviation 312 g) recorded, 24/12 (14.8%/7.4) developed any/severe IVH/PVL. Mean cStO2 was significantly lower in infants with IVH/PVL as well as severe IVH/PVL. In addition, we observed critical events defined by mean cStO2 over 5 min <60% in four infants with severe IVH/PVL during NIRS monitoring. AUT showed no statistically significant difference between outcome groups. CONCLUSION These findings suggest that cStO2 is lower in infants developing IVH/PVL. This may be related to lower oxygenation and/or perfusion and implies that cStO2 could potentially serve as an indicator of imminent cerebral lesions.
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Affiliation(s)
- Angelika L Schwab
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Dirk Bassler
- Neonatal Department, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Helmut D Hummler
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Hans W Fuchs
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Manuel B Bryant
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany.,Neonatal Department, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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Whittemore BA, Swift DM, M Thomas J, F Chalak L. A neonatal neuroNICU collaborative approach to neuromonitoring of posthemorrhagic ventricular dilation in preterm infants. Pediatr Res 2022; 91:27-34. [PMID: 33627823 DOI: 10.1038/s41390-021-01406-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/31/2023]
Abstract
Morbidity and mortality in prematurely born infants have significantly improved due to advancement in perinatal care, development of NeuroNICU collaborative multidisciplinary approaches, and evidence-based management protocols that have resulted from a better understanding of perinatal risk factors and neuroprotective treatments. In premature infants with intraventricular hemorrhage (IVH), the detrimental secondary effect of posthemorrhagic ventricular dilation (PHVD) on the neurodevelopmental outcome can be mitigated by surgical intervention, though management varies considerably across institutions. Any benefit derived from the use of neuromonitoring to optimize surgical timing and technique stands to improve neurodevelopmental outcome. In this review, we summarize (1) the approaches to surgical management of PHVD in preterm infants and outcome data; (2) neuromonitoring modalities and the effect of neurosurgical intervention on this data; (3) our resultant protocol for the monitoring and management of PHVD. In particular, our protocol incorporates cerebral near-infrared spectroscopy (NIRS) and transcranial doppler ultrasound (TCD) to better understand cerebral physiology and to enable the hypothesis-driven study of the management of PHVD. IMPACT: Review of the published literature concerning the use of near-infrared spectroscopy (NIRS) and a cerebral Doppler ultrasound to study the effect of cerebrospinal fluid drainage on infants with posthemorrhagic ventricular dilation. Presentation of our institution's evidence-based protocol for the use of NIRS and cerebral Doppler ultrasound to study the optimal neurosurgical treatment of posthemorrhagic ventricular dilation, an as yet inadequately studied area.
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Affiliation(s)
- Brett A Whittemore
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Dale M Swift
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer M Thomas
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Altit G, Bhombal S, Chock VY. End-organ saturations correlate with aortic blood flow estimates by echocardiography in the extremely premature newborn - an observational cohort study. BMC Pediatr 2021; 21:312. [PMID: 34253175 PMCID: PMC8274006 DOI: 10.1186/s12887-021-02790-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) measures of cerebral saturation (Csat) and renal saturation (Rsat) in extreme premature newborns may be affected by systemic blood flow fluctuations. Despite increasing clinical use of NIRS to monitor tissue saturation in the premature infant, validation of NIRS measures as a correlate of blood flow is still needed. We compared echocardiography (ECHO) derived markers of ascending aorta (AscAo) and descending aorta (DesAo) blood flow with NIRS measurements obtained during the ECHO. METHODS Newborns < 29 weeks' gestation (2013-2017) underwent routine NIRS monitoring. Csat, Rsat and systemic saturation at the time of ECHO were retrospectively analyzed and compared with Doppler markers of aortic flow. Renal and cerebral fractional tissue oxygen extraction (rFTOE and cFTOE, respectively) were calculated. Mixed effects models evaluated the association between NIRS and Doppler markers. RESULTS Forty-nine neonates with 75 Csat-ECHO and 62 Rsat-ECHO observations were studied. Mean post-menstrual age was 28.3 ± 3.8 weeks during the ECHO. Preductal measures including AscAo velocity time integral (VTI) and AscAo output were correlated with Csat or cFTOE, while postductal measures including DesAo VTI, DesAo peak systolic velocity, and estimated DesAo output were more closely correlated with Rsat or rFTOE. CONCLUSIONS NIRS measures are associated with aortic blood flow measurements by ECHO in the extremely premature population. NIRS is a tool to consider when following end organ perfusion in the preterm infant.
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Affiliation(s)
- Gabriel Altit
- Department of Pediatrics, Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, USA
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, USA
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13
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Artificial Intelligence Analysis of EEG Amplitude in Intensive Heart Care. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6284035. [PMID: 34306595 PMCID: PMC8272660 DOI: 10.1155/2021/6284035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023]
Abstract
This article first studied the morphological characteristics of the EEG for intensive cardiac care; that is, based on the analysis of the mechanism of disease diagnosis and treatment, a signal processing and machine learning model was constructed. Then, the methods of signal preprocessing, signal feature extraction, new neural network model structure, training mechanism, optimization algorithm, and efficiency are studied, and experimental verification is carried out for public data sets and clinical big data. Then, the principle of intensive cardiac monitoring, the mechanism of disease diagnosis, the types of arrhythmia, and the characteristics of the typical signal are studied, and the rhythm performance, individual variability, and neurophysiological basis of electrical signals in intensive cardiac monitoring are researched. Finally, the automatic signal recognition technology is studied. In order to improve the training speed and generalization ability, a multiclassification model based on Least Squares Twin Support Vector Machine (LS-TWIN-SVM) is proposed. The computational complexity of the classification model algorithm is compared, and intelligence is adopted. The optimization algorithm selects the parameters of the classifier and uses the EEG signal to simulate the model. Support Vector Machines and their improved algorithms have achieved the ultimum in shallow neural networks and have achieved good results in the classification and recognition of bioelectric signals. The LS-TWIN-SVM algorithm proposed in this paper has achieved good results in the classification and recognition of bioelectric signals. It can perform bioinformatics processing on intensive cardiac care EEG signals, systematically biometric information, diagnose diseases, the real-time detection, auxiliary diagnosis, and rehabilitation of patients.
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14
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Chawla S, Chock VY, Lakshminrusimha S. Intraventricular hemorrhage and white matter injury: is persistent cerebral desaturation a missing link? Pediatr Res 2021; 89:727-729. [PMID: 33247218 DOI: 10.1038/s41390-020-01294-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sanjay Chawla
- Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI, 48201, USA.
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA, 94304, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics-Neonatology, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
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15
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Schreiner C, Hammerl M, Neubauer V, Kiechl-Kohlendorfer U, Griesmaier E. Amplitude-integrated electroencephalography signals in preterm infants with cerebral hemorrhage. Early Hum Dev 2021; 154:105309. [PMID: 33465672 DOI: 10.1016/j.earlhumdev.2021.105309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether preterm infants with cerebral hemorrhage show alterations of aEEG signals in the first four weeks of life. STUDY DESIGN Preterm infants (n = 536) born before 32 completed weeks of pregnancy at Innsbruck Medical University Hospital were included in the study. AEEG recordings were evaluated for the Burdjalov score and cerebral hemorrhage was diagnosed by cerebral ultrasound. RESULTS Eighty preterm infants with cerebral hemorrhage (median gestational age 28.9 weeks, median birth weight 1157 g) and 456 preterm infants without cerebral hemorrhage (median gestational age 30.0 weeks, median birth weight 1300 g) were investigated. Burdjalov total scores were significantly lower in infants with cerebral hemorrhage. Infants with mild cerebral hemorrhage showed higher Burdjalov total scores compared to infants with severe cerebral hemorrhage in the first days of life. A Burdjalov total score of seven or more was predictive for no development of a cerebral hemorrhage, with a highest area under the curve (0.613) at postnatal day three. CONCLUSION Preterm infants with cerebral hemorrhage show alterations in aEEG signals in the newborn period. In future aEEG could be used as a supplemental method to monitor preterm infants at risk for cerebral hemorrhage. The use of aEEG in early life could reduce the number of ultrasound examinations and limit cumulative stress and discomfort in preterm infants.
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Affiliation(s)
- Christina Schreiner
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Marlene Hammerl
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Vera Neubauer
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elke Griesmaier
- Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria.
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16
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O'Toole JM, Dempsey EM, Van Laere D. Nonstationary coupling between heart rate and perfusion index in extremely preterm infants in the first day of life. Physiol Meas 2021; 42. [PMID: 33545702 DOI: 10.1088/1361-6579/abe3de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adaptation to the extra-uterine environment presents many challenges for infants born less than 28 weeks of gestation. Quantitative analysis of readily-available physiological signals at the cotside could provide valuable information during this critical time. We aim to assess the time-varying coupling between heart rate (HR) and perfusion index (PI) over the first 24 hours after birth and relate this coupling to gestational age, inotropic therapy, and short-term clinical outcome. APPROACH We develop new nonstationary measures of coupling to summarise both frequency- and direction-dependent coupling. These measures employ a coherence measure capable of measuring time-varying Granger casuality using a short-time information partial directed coherence function. Measures are correlated with gestational age, inotropic therapy (yes/no), and outcome (adverse/normal). MAIN RESULTS In a cohort of 99 extremely preterm infants (<28 weeks of gestation), we find weak but significant coupling in both the HR-to-PI and PI-to-HR directions (P<0.05). HR-to-PI coupling increases with maturation (correlation r=0.26; P=0.011); PI-to-HR coupling increases with inotrope administration (r=0.27; P=0.007). And nonstationary features of PI-to-HR coupling are associated with (r=0.27; P=0.009). SIGNIFICANCE Nonstationary features are necessary to distinguish different coupling types for complex biomedical systems. Time-varying directional coupling between PI and HR provides objective and independent biomarkers of adverse outcome in extremely preterm infants.
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Affiliation(s)
- John M O'Toole
- INFANT Research Centre, University College Cork National University of Ireland, Cork, IRELAND
| | - Eugene M Dempsey
- INFANT Research Centre, , University College Cork National University of Ireland, Cork, IRELAND
| | - David Van Laere
- Department of Neonatal Intensive Care, University Hospital Antwerp, Edegem, Antwerp, BELGIUM
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17
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Association between early cerebral oxygenation and neurodevelopmental impairment or death in premature infants. J Perinatol 2021; 41:743-748. [PMID: 33589727 PMCID: PMC7883949 DOI: 10.1038/s41372-021-00942-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/15/2020] [Accepted: 01/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the relationship between cerebral oxygenation in the first 72 h of life and neurodevelopmental impairment (NDI) at 2 years corrected age in former premature infants. STUDY DESIGN Prospective observational cohort study of 127 infants <32 weeks GA at birth with cerebral oxygenation monitoring using NIRS in the first 72 h of life. RESULTS Using a threshold cutoff for cerebral hypoxia, infants with NDI or death had increased duration of hypoxia (4 vs 2.3%, p = 0.001), which was more pronounced in the 23-27 week subgroup (7.6 vs 3.2%, p < 0.001). Individual generalized estimating equations to adjust for repeated measures were modeled in this subgroup for the physiologic parameters including StO2. StO2 < 67% was a predictor for death or NDI (OR 2.75, 95% CI 1.006, 7.5132, p = 0.049). CONCLUSION An increased duration of cerebral hypoxia is associated with NDI or death in infants born <32 weeks GA.
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18
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Katheria AC, Szychowski JM, Essers J, Mendler MR, Dempsey EM, Schmölzer GM, Arnell K, Rich WD, Hassen K, Allman P, Varner M, Cutter GR, Finer N. Early Cardiac and Cerebral Hemodynamics with Umbilical Cord Milking Compared with Delayed Cord Clamping in Infants Born Preterm. J Pediatr 2020; 223:51-56.e1. [PMID: 32482392 PMCID: PMC7387184 DOI: 10.1016/j.jpeds.2020.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To evaluate changes in cerebral oxygenation, peripheral arterial oxygenation, respiratory status, and administered fraction of inspired oxygen during the first 10 minutes of life in premature infants receiving umbilical cord milking compared with delayed cord clamping (DCC). STUDY DESIGN Premature infants born at 230/7 to 276/7 weeks of gestation were randomized to umbilical cord milking or DCC. A near infrared spectroscopy sensor, pulse oximeter, and electrocardiogram electrodes were placed. Pulse rate, cerebral tissue oxygenation, peripheral oxygen saturation, airway pressure, and fraction of inspired oxygen were collected for 10 minutes in the delivery room. Longitudinal models were used to compare effects of umbilical cord milking and DCC. RESULTS Fifty-six infants had cerebral oximetry and advanced monitoring at birth. There was an increased incidence of severe intraventricular hemorrhage in infants who received umbilical cord milking compared with DCC (P = .0211). Longitudinal models suggested that peripheral oxygen saturation was higher in the umbilical cord milking group in the first 4 minutes (P = .0221) and that mean airway pressures were lower in the umbilical cord milking group after the first 7 minutes (P = .0072). No statistical differences were observed for fraction of inspired oxygen, cerebral tissue oxygenation, or heart rates. CONCLUSIONS The data suggest that the rapid transfer of blood during umbilical cord milking may facilitate lung expansion with improved pulmonary blood flow, but may also increase cerebral blood flow, resulting in severe intraventricular hemorrhage. TRIAL REGISTRATION ClinicalTrials.gov: NCT03145142.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
| | - Jeff M Szychowski
- Department of Biostatistics at the UAB School of Public Health, Birmingham, AL, United States
| | - Jochen Essers
- Department of Pediatrics University of Ulm, Ulm, Germany
| | - Marc R Mendler
- Department of Pediatrics University of Ulm, Ulm, Germany
| | - Eugene M Dempsey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kathy Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Wade D Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Kasim Hassen
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Phillip Allman
- Department of Biostatistics at the UAB School of Public Health, Birmingham, AL, United States
| | - Michael Varner
- Department of Obstetrics, University of Utah, Salt Lake City, UT, United States
| | - Gary R Cutter
- Department of Biostatistics at the UAB School of Public Health, Birmingham, AL, United States
| | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
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19
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Agarwal P, Sharma A, Farooqi A, Natarajan G. Impact of different cord clamping strategies on short term neuromonitoring among preterm infants: a randomized, controlled trial. J Perinatol 2020; 40:1115-1118. [PMID: 32398738 DOI: 10.1038/s41372-020-0684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Prashant Agarwal
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA.
| | - Amit Sharma
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA
| | - Ahmad Farooqi
- Children's Research Center of Michigan, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA
| | - Girija Natarajan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA
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20
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Resuscitation outcomes of infants that do not achieve a 5 min target SpO 2 saturation. J Perinatol 2019; 39:1635-1639. [PMID: 31488904 DOI: 10.1038/s41372-019-0491-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/01/2019] [Accepted: 07/12/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine differences in the duration and level of resuscitation between infants that achieve a peripheral oxygen saturation (SpO2) of 80% by 5 min compared with those who remain below 80% saturation. STUDY DESIGN Infants < 32 weeks GA were analyzed. Pulse rate, SpO2, airway pressure, and fraction of inspired oxygen were collected during the first 10 min of life. RESULTS Two hundred and eighty-four infants were analyzed of which 100 had SpO2 < 80% at 5 min of life. Composite outcome of death and any IVH was greater in the <80% at 5 min group. These infants had lower heart rates and lower SpO2 despite increased mean airway pressure and higher FiO2 (p < 0.001). CONCLUSION Infants <32 weeks GA that do not achieve a peripheral arterial saturation of 80% by 5 min of life experience more death or severe IVH. This association is amongst the strongest seen of any predictor of morbidity in the delivery room.
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21
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Lim J, Hagen E. Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors. Neoreviews 2019; 20:e452-e463. [PMID: 31371554 DOI: 10.1542/neo.20-8-e452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Germinal matrix hemorrhage-intraventricular hemorrhage (IVH) is the most common form of brain injury in preterm infants. Although severe IVH has declined over the years, it still affects approximately 6% of infants born before 32 weeks of gestation. Most IVH cases are detectable by the first 24 hours after birth; therefore interventions to prevent IVH should focus on antenatal management for pregnant women and delivery room management. Obstetrical interventions, including antenatal corticosteroids, maternal rather than infant transport, and possibly elective cesarean delivery have been associated with a decreased risk of IVH. Neonatal interventions in the delivery room, including delayed cord clamping or umbilical cord milking, maintaining normothermia, avoiding fluctuations in cerebral blood flow, and optimal ventilation management are associated with a decreased risk of IVH. Multiple clinical trials are under way to further identify IVH risk factors, ability to monitor or predict IVH, and ideally prevent IVH altogether. This discussion will focus on reviewing current obstetric and neonatal management practices and their associations with germinal matrix hemorrhage-IVH.
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Affiliation(s)
- Jina Lim
- Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, CA
| | - Eunice Hagen
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
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22
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Finn D, Ryan DH, Pavel A, O'Toole JM, Livingstone V, Boylan GB, Kenny LC, Dempsey EM. Clamping the Umbilical Cord in Premature Deliveries (CUPiD): Neuromonitoring in the Immediate Newborn Period in a Randomized, Controlled Trial of Preterm Infants Born at <32 Weeks of Gestation. J Pediatr 2019; 208:121-126.e2. [PMID: 30879732 DOI: 10.1016/j.jpeds.2018.12.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare cerebral activity and oxygenation in preterm infants (<32 weeks of gestation) randomized to different cord clamping strategies. STUDY DESIGN Preterm infants born at <32 weeks of gestation were randomized to immediate cord clamping, umbilical cord milking (cord stripped 3 times), or delayed cord clamping for 60 seconds with bedside resuscitation. All infants underwent electroencephalogram (EEG) and cerebral near infrared spectroscopy for the first 72 hours after birth. Neonatal primary outcome measures were quantitative measures of the EEG (17 features) and near infrared spectroscopy over 1-hour time frames at 6 and 12 hours of life. RESULTS Forty-five infants were recruited during the study period. Twelve infants (27%) were randomized to immediate cord clamping, 19 (42%) to umbilical cord milking, and 14 (31%) to delayed cord clamping with bedside resuscitation. There were no significant differences between groups for measures of EEG activity or cerebral near infrared spectroscopy. Three of the 45 infants (6.7%) were diagnosed with severe IVH (2 in the immediate cord clamping group, 1 in the umbilical cord milking group; P = .35). CONCLUSIONS There were no differences in cerebral EEG activity and cerebral oxygenation values between cord management strategies at 6 and 12 hours. TRIAL REGISTRATION ISRCTN92719670.
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Affiliation(s)
- Daragh Finn
- Department of Pediatrics and Child Health, Cork University Maternity Hospital, Cork Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland.
| | - Deirdre Hayes Ryan
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland; Department of Obstetrics, Cork University Maternity Hospital, Cork Ireland
| | - Andreea Pavel
- Department of Pediatrics and Child Health, Cork University Maternity Hospital, Cork Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - John M O'Toole
- Department of Pediatrics and Child Health, Cork University Maternity Hospital, Cork Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- Department of Pediatrics and Child Health, Cork University Maternity Hospital, Cork Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- Department of Pediatrics and Child Health, Cork University Maternity Hospital, Cork Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland; Department of Obstetrics, Cork University Maternity Hospital, Cork Ireland
| | - Eugene M Dempsey
- Department of Pediatrics and Child Health, Cork University Maternity Hospital, Cork Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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23
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Variane GFT, Chock VY, Netto A, Pietrobom RFR, Van Meurs KP. Simultaneous Near-Infrared Spectroscopy (NIRS) and Amplitude-Integrated Electroencephalography (aEEG): Dual Use of Brain Monitoring Techniques Improves Our Understanding of Physiology. Front Pediatr 2019; 7:560. [PMID: 32039117 PMCID: PMC6985148 DOI: 10.3389/fped.2019.00560] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/23/2019] [Indexed: 01/10/2023] Open
Abstract
Continuous brain monitoring tools are increasingly being used in the neonatal intensive care unit (NICU) to assess brain function and cerebral oxygenation in neonates at high risk for brain injury. Near infrared spectroscopy (NIRS) is useful in critically ill neonates as a trend monitor to evaluate the balance between tissue oxygen delivery and consumption, providing cerebral and somatic oximetry values, and allowing earlier identification of abnormalities in hemodynamics and cerebral perfusion. Amplitude-integrated electroencephalography (aEEG) is a method for continuous monitoring of cerebral function at the bedside. Simultaneous use of both monitoring modalities may improve the understanding of alterations in hemodynamics and risk of cerebral injury. Several studies have described correlations between aEEG and NIRS monitoring, especially in infants with hypoxic-ischemic encephalopathy (HIE), but few describe the combined use of both monitoring techniques in a wider range of clinical scenarios. We review the use of NIRS and aEEG in neonates and describe four cases where abnormal NIRS values were immediately followed by changes in brain activity as seen on aEEG allowing the impact of a hemodynamic disturbance on the brain to be correlated with the changes in the aEEG background pattern. These four clinical scenarios demonstrate how simultaneous neuromonitoring with aEEG and NIRS provides important clinical information. We speculate that routine use of these combined monitoring modalities may become the future standard for neonatal neuromonitoring.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Grupo Santa Joana, Division of Neonatology, São Paulo, Brazil.,Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.,Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Alexandre Netto
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.,Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Rafaela Fabri Rodrigues Pietrobom
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.,Protecting Brains and Saving Futures Organization, São Paulo, Brazil.,Neonatal Unit, Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, São Paulo, Brazil
| | - Krisa Page Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States
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24
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Binder-Heschl C, Pichler G, Avian A, Schwaberger B, Baik-Schneditz N, Mileder L, Heschl S, Urlesberger B. Oxygen Saturation Targeting During Delivery Room Stabilization: What Does This Mean for Regional Cerebral Oxygenation? Front Pediatr 2019; 7:274. [PMID: 31312625 PMCID: PMC6614436 DOI: 10.3389/fped.2019.00274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate if preterm neonates with arterial oxygen saturation (SpO2)<80% at 5 min after birth show different regional cerebral tissue oxygen saturation (rcStO2), compared to infants reaching the target. Methods: Retrospective analysis of four prospective observational studies. Preterm neonates needing respiratory support during delivery room stabilization were included. Regional cerebral tissue oxygen saturation was measured with near-infrared spectroscopy (NIRS) during the first 15 min after birth along with SpO2 and heart rate (HR). Neonates were divided into two groups: those with a 5-min SpO2 ≥ 80% ("≥80% group") and those with a 5-min SpO2 < 80% ("<80% group"). Groups were compared regarding rcStO2, SpO2, and HR. Furthermore, we analyzed whether a 5-min SpO2 < 80% was associated with a rcStO2 below the 10th percentile at the same time point. Results: 146 neonates were included, with 68 (47%) in the "≥80% group" and 78 (53%) in the "<80% group." Neonates in the " <80% group" had a significantly lower rcStO2 (p < 0.001). Furthermore, 80.3% of neonates in the " <80% group" and 23.4% in the "≥80% group" had rcStO2 values below the 10th percentile at 5 min (p < 0.001). HR was significantly lower at minute 3 and 4 in the " <80% group" (p < 0.002). Conclusion: Preterm infants needing respiratory support, who do not reach the SpO2 target of 80% at 5 min after birth, show significantly diminished rcStO2 values compared to neonates reaching the target.
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Affiliation(s)
- Corinna Binder-Heschl
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Nariae Baik-Schneditz
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Lukas Mileder
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Stefan Heschl
- Department of Anesthesiology and Intensive Care Medicine, Pediatric Anesthesia, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics, Medical University of Graz, Graz, Austria
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