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古丽佐合热· 阿, 努尔亚· 热. [Application of near-infrared spectroscopy in the early identification of neonatal gastrointestinal diseases]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:523-528. [PMID: 38802915 PMCID: PMC11135058 DOI: 10.7499/j.issn.1008-8830.2311148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/19/2024] [Indexed: 05/29/2024]
Abstract
Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal diseases in neonatal intensive care units, characterized by rapid progression and a high mortality rate. Local intestinal ischemia and hypoxia are significant contributors to NEC. Feeding intolerance (FI), which refers to a range of gastrointestinal manifestations arising from the inability to tolerate enteral nutrition, is one of the most common clinical issues in neonates, and preventing and treating FI is crucial for improving neonatal survival rates. Near-infrared spectroscopy is a clinical tool that can be used at the bedside to monitor regional oxygen saturation. It is non-invasive, reliable, and sustainable, and its feasibility and safety in assessing intestinal blood circulation have been validated. Early identification of intestinal ischemia and differentiation of FI from precursor symptoms of NEC, as well as predicting the occurrence of NEC, are extremely important for reducing intestinal injury and adverse long-term outcomes. In recent years, there has been new research progress related to the monitoring of intestinal tissue oxygen saturation and cerebral oxygen saturation for the early identification of FI and precursor symptoms of NEC, and this article provides a review of these developments.
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Kooi EMW, Mintzer JP, Rhee CJ, Ergenekon E, Schwarz CE, Pichler G, de Boode WP. Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy : Part of the series on near-infrared spectroscopy by the European Society of Paediatric Research Special Interest Group "Near-Infrared Spectroscopy". Pediatr Res 2024:10.1038/s41390-024-03226-z. [PMID: 38730022 DOI: 10.1038/s41390-024-03226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
In this narrative review, we summarize the current knowledge and applications of somatic near-infrared spectroscopy (NIRS), with a focus on intestinal, renal, limb, and multi-site applications in neonates. Assessing somatic oxygenation at various body locations in neonates may aid in the understanding of underlying pathophysiology of organ injury. Considering cerebral autoregulation may be active to protect the brain during systemic circulatory failure, peripheral somatic oxygenation may potentially provide an early indication of neonatal cardiovascular failure and ultimate hypoxemic injury to vital organs including the brain. Certain intestinal oxygenation patterns appear to be associated with the onset and course of necrotizing enterocolitis, whereas impaired renal oxygenation may indicate the onset of acute kidney injury after various types of hypoxic events. Peripheral muscle oxygenation measured at a limb may be particularly effective in the early prediction of shock in neonates. Using multi-site NIRS may complement current approaches and clinical investigations to alert for neonatal tissue hypoxemia, and potentially even guide management. However, somatic NIRS has its inherent limitations in regard to accuracy. Interpretation of organ-specific values can also be challenging. Last, currently there are limited prospective intervention studies, and clinical benefits need to be examined further, after the clarification of critical threshold-values. IMPACT: The assessment of somatic oxygenation using NIRS may contribute to the prediction of specific diseases in hemodynamically challenged neonates. Furthermore, it may give early warning signs for impending cardiovascular failure, and impaired cerebral circulation and oxygenation. We present a comprehensive overview of the literature on applications of NIRS to various somatic areas, with a focus on its potential clinical applicability, including future research directions. This paper will enable prospective standardized studies, and multicenter collaboration to obtain statistical power, likely to advance the field.
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Affiliation(s)
- Elisabeth M W Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | | | | | - Christoph E Schwarz
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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Murphy C, Baskind S, Aladangady N, Banerjee J. Measuring gut perfusion and blood flow in neonates using ultrasound Doppler of the superior mesenteric artery: a narrative review. Front Pediatr 2023; 11:1154611. [PMID: 37601136 PMCID: PMC10433905 DOI: 10.3389/fped.2023.1154611] [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: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 08/22/2023] Open
Abstract
The gut is a relatively silent organ in utero but takes on a major role after birth for the absorption and digestion of feed for adequate nutrition and growth. The neonatal circulation undergoes a transition period after birth, and gut perfusion increases rapidly to satisfy the oxygen demand and consumption. If this process is compromised at any stage, preterm and fetal growth restricted infants are at particular risk of gut tissue injury secondary to hypoxia, leading to necrotizing enterocolitis. Feeding can also be a challenge in these high-risk groups due to gut dysmotility. Superior mesenteric artery (SMA) Doppler is a safe, bedside investigation that could rapidly aid clinicians with feeding strategies and in monitoring high-risk infants. This article aims to establish normal patterns of gut blood flow velocity in neonates using SMA Doppler and reviews how it might be used clinically in pathologic states.
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Affiliation(s)
- C. Murphy
- Neonatal Intensive Care Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Neonatal Intensive Care Unit, Queen Mary University of London, London, United Kingdom
| | - S. Baskind
- Neonatal Intensive Care Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - N. Aladangady
- Neonatal Intensive Care Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Neonatal Intensive Care Unit, Queen Mary University of London, London, United Kingdom
| | - J. Banerjee
- Neonatal Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
- Neonatal Intensive Care Unit, Imperial College London, London, United Kingdom
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Surmeli Onay O, Velipasaoğlu M, Tutal M, Sarılar TD, Cakıl Saglık A, Bilgin M, Aydemir O, Barsan Kaya T, Tanır HM, Tekin AN. The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial. Eur J Pediatr 2023; 182:1317-1328. [PMID: 36637540 DOI: 10.1007/s00431-023-04810-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants' fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without. Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation. Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495, https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist= . Retrospectively registered, date of registration: August 2022. What is Known: • It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation. What is New: • The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent). • In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.
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Affiliation(s)
- Ozge Surmeli Onay
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Melih Velipasaoğlu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Merve Tutal
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tevhide Derya Sarılar
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Adviye Cakıl Saglık
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozge Aydemir
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tugba Barsan Kaya
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Mete Tanır
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ayşe Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Walker SB, Badke CM, Carroll MS, Honegger KS, Fawcett A, Weese-Mayer DE, Sanchez-Pinto LN. Novel approaches to capturing and using continuous cardiorespiratory physiological data in hospitalized children. Pediatr Res 2023; 93:396-404. [PMID: 36329224 DOI: 10.1038/s41390-022-02359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/16/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Continuous cardiorespiratory physiological monitoring is a cornerstone of care in hospitalized children. The data generated by monitoring devices coupled with machine learning could transform the way we provide care. This scoping review summarizes existing evidence on novel approaches to continuous cardiorespiratory monitoring in hospitalized children. We aimed to identify opportunities for the development of monitoring technology and the use of machine learning to analyze continuous physiological data to improve the outcomes of hospitalized children. We included original research articles published on or after January 1, 2001, involving novel approaches to collect and use continuous cardiorespiratory physiological data in hospitalized children. OVID Medline, PubMed, and Embase databases were searched. We screened 2909 articles and performed full-text extraction of 105 articles. We identified 58 articles describing novel devices or approaches, which were generally small and single-center. In addition, we identified 47 articles that described the use of continuous physiological data in prediction models, but only 7 integrated multidimensional data (e.g., demographics, laboratory results). We identified three areas for development: (1) further validation of promising novel devices; (2) more studies of models integrating multidimensional data with continuous cardiorespiratory data; and (3) further dissemination, implementation, and validation of prediction models using continuous cardiorespiratory data. IMPACT: We performed a comprehensive scoping review of novel approaches to capture and use continuous cardiorespiratory physiological data for monitoring, diagnosis, providing care, and predicting events in hospitalized infants and children, from novel devices to machine learning-based prediction models. We identified three key areas for future development: (1) further validation of promising novel devices; (2) more studies of models integrating multidimensional data with continuous cardiorespiratory data; and (3) further dissemination, implementation, and validation of prediction models using cardiorespiratory data.
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Affiliation(s)
- Sarah B Walker
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Colleen M Badke
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael S Carroll
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kyle S Honegger
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Andrea Fawcett
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Debra E Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - L Nelson Sanchez-Pinto
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants. J Perinatol 2022:10.1038/s41372-022-01576-2. [PMID: 36496514 DOI: 10.1038/s41372-022-01576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Near-infrared spectroscopy (NIRS) allows assessment of regional tissue oxygen delivery and extraction. There are doubts regarding reliability of gut NIRS measurements. This study assesses reliability of NIRS for monitoring gut oxygenation. STUDY DESIGN Splanchnic tissue haemoglobin index (sTHI), tissue oxygenation index (sTOI) and fractional tissue oxygen extraction (sFTOE) changes during blood transfusion were measured using NIRS and compared to stable control infants. Infants were grouped into 3 chronological age groups: 1-7, 8-28 and ≥29 days of life. RESULTS sTHI, sTOI significantly increased, and sFTOE reduced following blood transfusion in all age group infants (n = 59), with no changes seen in control infants (n = 12). Baseline characteristics including gestational age and feed volumes did not differ between groups. CONCLUSION Gut perfusion measured by NIRS improved in infants who received blood transfusion, a change not seen in the control group, thus suggesting NIRS is a reliable method to measure splanchnic tissue oxygenation.
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7
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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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Chock VY, Smith E, Tan S, Ball MB, Das A, Hintz SR, Kirpalani H, Bell EF, Chalak LF, Carlo WA, Cotten CM, Widness JA, Kennedy KA, Ohls RK, Seabrook RB, Patel RM, Laptook AR, Mancini T, Sokol GM, Walsh MC, Yoder BA, Poindexter BB, Chawla S, D’Angio CT, Higgins RD, Van Meurs KP. Early brain and abdominal oxygenation in extremely low birth weight infants. Pediatr Res 2022; 92:1034-1041. [PMID: 35513716 PMCID: PMC9588487 DOI: 10.1038/s41390-022-02082-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/24/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined. METHODS A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables. RESULTS In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001). CONCLUSION Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population. IMPACT Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies. Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases. A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome. Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.
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Affiliation(s)
- Valerie Y. Chock
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA,Corresponding author: Valerie Y. Chock, MD, MS Epi, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA. 94304 USA, (650) 723-5711,
| | - Emily Smith
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Sylvia Tan
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - M. Bethany Ball
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Haresh Kirpalani
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Lina F. Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Kathleen A. Kennedy
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Robin K. Ohls
- University of New Mexico Health Sciences Center, Albuquerque, NM,Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ruth B. Seabrook
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Ravi M. Patel
- Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Toni Mancini
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Bradley A. Yoder
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Brenda B. Poindexter
- Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Sanjay Chawla
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Carl T. D’Angio
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD,College of Health and Human Services, George Mason University, Fairfax, VA
| | - Krisa P. Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
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Splanchnic oxygen saturation during reoxygenation with 21% or 100% O 2 in newborn piglets. Pediatr Res 2022; 92:445-452. [PMID: 34725499 DOI: 10.1038/s41390-021-01819-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing evidence recognizes the harm of excess oxygen to lungs, eyes, and brain of preterm infants, but not yet to the intestine. We assessed changes in splanchnic oxygenation during reoxygenation with 21% compared to 100% O2 in a newborn piglet model of perinatal asphyxia. METHODS We randomized 25 piglets to control or intervention. Intervention groups underwent global hypoxia until acidosis and hypotension occurred. Piglets were reoxygenated for 30 min with 21% or 100% O2 and observed for 9 h. We continuously measured regional splanchnic oxygen saturation (rsSO2) using near-infrared spectroscopy (NIRS). We calculated mean rsSO2 and rsCoVar (as SD/mean). We measured PaO2 and SaO2, sampled from the right carotid artery. RESULTS Reoxygenation after global hypoxia restored rsSO2. Reoxygenation with 100% O2 increased rsSO2 to values significantly higher than baseline. In intervention groups, rsCoVar decreased during observation compared to baseline. We found a correlation between rsSO2 and PaO2 (r = 0.420, P < 0.001) and between rsSO2 and SaO2 (r = 0.648, P < 0.001) in pooled data from the entire experiment. CONCLUSION Reoxygenation after global hypoxia improves splanchnic oxygenation, but is associated with reduced variability of rsSO2. Reoxygenation with 100% O2 exposes the intestine to hyperoxia. Splanchnic NIRS is able to detect intestinal hypoxia and hyperoxia. IMPACT Splanchnic oxygenation improves during reoxygenation after global hypoxia, though reoxygenation with 100% O2 exposes the intestine to hyperoxia. Decreased variability of splanchnic oxygenation several hours after hypoxia and reoxygenation seems to be independent of the resuscitation strategy, and may indicate intestinal injury. Splanchnic NIRS monitoring was able to detect intestinal hypoxia and exposure to hyperoxia, as evidenced by a strong correlation between splanchnic oxygenation and arterial oxygen content.
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Sirota GL, Litmanovitz I, Vider C, Arnon S, Moore SS, Grinblatt E, Levkovitz O, Bauer Rusek S. Regional Splanchnic Oxygenation during Continuous versus Bolus Feeding among Stable Preterm Infants. CHILDREN 2022; 9:children9050691. [PMID: 35626866 PMCID: PMC9139727 DOI: 10.3390/children9050691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/24/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022]
Abstract
Introduction: There is no agreement regarding the best method for tube-feeding preterm infants. Few studies, to date, have evaluated the influence of different methods of enteral feeding on intestinal oxygenation. The use of near-infrared spectroscopy (NIRS) has permitted the noninvasive measurement of splanchnic regional oxygenation (rSO2S) in different clinical conditions. The aim of this prospective, single-center study was to compare rSO2S during continuous versus bolus feeding among stable preterm infants. Methods: Twenty-one preterm infants, less than 32 weeks gestation and appropriate for gestational age, were enrolled. All infants were clinically stable and on full tube feedings. Each infant received a bolus feeding initially (20 min duration), and after 3 h, a continuous feeding (5 h duration). Infants were evaluated 30 min before and 30 min after the bolus and continuous feedings. The regional splanchnic saturation (rSO2S) was measured using near-infrared spectroscopy (NIRS) technology and systemic saturation was measured with pulse oximetry. From these measurements, we calculated the splanchnic fractional oxygen extraction ratio (FOES) for each of the four intervals. Results: rSO2S decreased after continuous vs. bolus feeding (p = 0.025), while there was a trend toward decreased SaO2 after bolus feeding (p = 0.055). The FOES, which reflects intestinal oxygen extraction, was not affected by the feeding mode (p = 0.129). Discussion/Conclusion: Continuous vs. bolus feeding decreases rSO2S but does not affect oxygen extraction by intestinal tissue; after bolus feeding there was a trend towards decreased systemic saturation.
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Affiliation(s)
- Gisela Laura Sirota
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
- Correspondence: ; Tel.: +972-50-538-2266
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Carmel Vider
- Department of Pediatrics, Meir Medical Center, Kfar-Saba 4428164, Israel;
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shiran Sara Moore
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
| | - Eynit Grinblatt
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
| | - Orly Levkovitz
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
| | - Sofia Bauer Rusek
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164, Israel; (I.L.); (S.A.); (S.S.M.); (E.G.); (O.L.); (S.B.R.)
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Viraraghavan VR, Sanghamitra GS. Early prediction of feed intolerance in very low birth weight preterm infants using superior mesenteric artery blood flow velocity - correspondence. J Matern Fetal Neonatal Med 2022; 35:1577. [PMID: 32345076 DOI: 10.1080/14767058.2020.1759530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Howarth CN, Leung TS, Banerjee J, Eaton S, Morris JK, Aladangady N. Regional cerebral and splanchnic tissue oxygen saturation in preterm infants - Longitudinal normative measurements. Early Hum Dev 2022; 165:105540. [PMID: 35065416 DOI: 10.1016/j.earlhumdev.2022.105540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate regional splanchnic and cerebral tissue oxygen saturation in preterm infants <30 weeks gestation. METHODS Cerebral (cTOI) and splanchnic (sTOI) Tissue Oxygenation Index were measured weekly in 5 min epochs for a total period of 60 min using NIRS (NIRO-300) for the first 8 weeks of life, in 48 appropriately grown preterm infants born at <30 weeks gestation. Infants who developed HPI and/or NEC (n = 12) and those that died (n = 1) were excluded from our main outcome measure of regional gut and cerebral tissue oxygenation in healthy preterm infants <30 weeks gestation. RESULTS Median birthweight 789 g (460-1486), gestational age 25+6 weeks (23+0-29+1) and 51.4% female. 217 NIRS measurements were completed across the first 8 weeks of life. Mean weekly cTOI ranged from 56.8-65.4% and sTOI ranged from 36.7-46.0%. Mean cTOI was significantly higher than mean sTOI (p < 0.001) throughout the first 8 weeks of life. Mean cTOI decreased significantly with increasing postnatal age [-0.59% each week (-1.26% to -0.07%) p = 0.04]. None of the examined confounding factors had a significant effect. CONCLUSIONS This is the first report of regional cerebral and splanchnic tissue oxygen saturation ranges during the first 8 weeks of life for preterm infants born at <30 weeks gestation.
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Affiliation(s)
- Claire N Howarth
- Homerton University Hospital NHS Foundation Trust, London, UK; Queen Mary University of London, London, UK.
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Jayanta Banerjee
- Imperial College Healthcare NHS Trust, London, UK; Imperial College London, UK
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Narendra Aladangady
- Homerton University Hospital NHS Foundation Trust, London, UK; Queen Mary University of London, London, UK
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13
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Howarth C, Banerjee J, Leung T, Aladangady N. Could Near Infrared Spectroscopy (NIRS) be the new weapon in our fight against Necrotising Enterocolitis? Front Pediatr 2022; 10:1024566. [PMID: 36425397 PMCID: PMC9679512 DOI: 10.3389/fped.2022.1024566] [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: 08/21/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
There is no ideal single gut tissue or inflammatory biomarker available to help to try and identify Necrotising Enterocolitis (NEC) before its clinical onset. Neonatologists are all too familiar with the devastating consequences of NEC, and despite many advances in neonatal care the mortality and morbidity associated with NEC remains significant. In this article we review Near Infrared Spectroscopy (NIRS) as a method of measuring regional gut tissue oxygenation. We discuss its current and potential future applications, including considering its effectiveness as a possible new weapon in the early identification of NEC.
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Affiliation(s)
- Claire Howarth
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - Jayanta Banerjee
- Neonatal Unit, Imperial College Healthcare NHS Trust and Imperial College London, London, United Kingdom
| | - Terence Leung
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Narendra Aladangady
- Neonatal Unit, Homerton Healthcare NHS Foundation Trust, London, United Kingdom.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, United Kingdom
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Metcalfe KHM, Stienstra R, McHoney M. NIRS as a biomarker of bowel ischaemia & surgical pathology: A meta-analysis of studies in newborns. Early Hum Dev 2021; 161:105437. [PMID: 34411803 DOI: 10.1016/j.earlhumdev.2021.105437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We performed a meta-analysis on Near-infrared Spectroscopy (NIRS) as a biomarker of bowel ischaemia. SUMMARY BACKGROUND DATA NIRS allows non-invasive assessment of gastrointestinal regional oxygen saturation (GrSO2). Studies to date have focused on the feasibility of NIRS in clinical practice and its reproducibility. GrSO2 can be used alone, or in conjunction with cerebral NIRS to give a Cerebral Splanchnic Oxygenation Ratio (CSOR). We assess published data on abdominal NIRS as a marker of bowel ischaemia. METHODS A literature review was conducted using the PRISMA method. Data on GrSO2 and CSOR in controls and patients with confirmed ischaemia was included in a meta-analysis, and used to identify a diagnostic threshold. RESULTS 14 studies were identified. Meta-analysis demonstrated that GrSO2 (p < 0.01) and CSOR (p < 0.01) were significantly lower in neonates with bowel pathology associated with ischaemia than controls. Area under the curve for GrSO2 was 0.80, with Youden's index highest (0.52) at a GrSO2 of 42% (specificity 91% and sensitivity 62%). For CSOR, area under the curve is 0.89, with Youden's index highest (0.69) at 0.76 (specificity of 80%, sensitivity 90%). CONCLUSIONS Splanchnic NIRS correlates with bowel ischaemia. Low GrSO2 is consistently associated with ischaemia, although a specific cut off level in each patient is hard to define. However, values below 42% correlate strongly with ischaemia while values above 52% are more suggestive of patients without bowel pathology. CSOR of below 0.76 is strongly suggestive of ischaemia. Trends within individuals are likely to be able to provide even more clinically correlatable and diagnostic data.
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Affiliation(s)
- Kiloran H M Metcalfe
- University of Edinburgh, College of Medicine, United Kingdom of Great Britain and Northern Ireland
| | - Roxane Stienstra
- Department Paediatric Surgery, Royal Hospital for sick Children Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Merrill McHoney
- University of Edinburgh, College of Medicine, United Kingdom of Great Britain and Northern Ireland; Department Paediatric Surgery, Royal Hospital for sick Children Edinburgh, United Kingdom of Great Britain and Northern Ireland.
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15
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黄 循, 钟 晓, 刘 婷, 程 国, 丘 惠. Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus: a prospective research. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:821-827. [PMID: 34511172 PMCID: PMC8428912 DOI: 10.7499/j.issn.1008-8830.2103196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the change in regional oxygen saturation (rSO2) of intestinal tissue in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) by near-infrared spectroscopy, and the clinical significance of the change in intestinal oxygen level in preterm infants with hsPDA. METHODS The preterm infants with patent ductus arteriosus (PDA) who had gestational age <32 weeks and/or birth weight <1 500 g were prospectively enrolled, who were admitted to the Department of Neonatology, Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA, the preterm infants with patent ductus arteriosus (PDA) were divided into two groups: hsPDA and non-hsPDA. According to closure of the ductus arteriosus after oral administration of ibuprofen, the preterm infants in the hsPDA group were subdivided into two groups: hsPDA closure and hsPDA non-closure. Hemodynamic parameters were measured at diagnosis of PDA and after treatment, and the level of intestinal tissue rSO2 was monitored continuously to analyze its change. RESULTS A total of 241 preterm infants with PDA were enrolled, with 55 infants (22.8%) in the hsPDA group and 186 infants (77.2%) in the non-hsPDA group. There were 36 infants (65%) in the hsPDA closure group and 19 infants (35%) in the hsPDA non-closure group. Compared with the non-hsPDA group, the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 6 hours after diagnosis (1, 2, 4, and 6 hours), the hsPDA group had significantly lower intestinal tissue rSO2 than the non-hsPDA group (P<0.05), and intestinal tissue rSO2 gradually decreased over time in the hsPDA group (P<0.05), with the lowest level of 0.448±0.014 at 6 hours. Compared with the hsPDA non-closure group, the hsPDA closure group had a significantly lower left atrial diameter/aortic root diameter ratio and significantly higher left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 48-96 hours after treatment (48, 72, and 96 hours), the hsPDA closure group had significantly higher intestinal tissue rSO2 than the hsPDA non-closure group (P<0.05), and intestinal tissue rSO2 gradually increased since 24 hours after treatment in the hsPDA closure group (P<0.05), with the highest level of 0.578±0.031 at 96 hours. CONCLUSIONS hsPDA has an impact on intestinal tissue oxygenation in preterm infants, and continuous monitoring of intestinal tissue rSO2 by near-infrared spectroscopy can help to guide the clinical management of hsPDA in preterm infants.
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Abstract
OBJECTIVE The aim of this study is to assess the effects of administering 20 mg/kg loading dose of caffeine citrate intravenously on splanchnic oxygenation in preterm infants. STUDY DESIGN The infants with a gestational age (GA) of <34 weeks who were administered with a 20 mg/kg intravenous loading dose of caffeine citrate within 48 hours after birth were investigated prospectively. Regional splanchnic oxygen saturation (rsSO2) and splanchnic fractional tissue oxygen extraction rate (sFTOE) were measured using near-infrared spectroscopy before caffeine infusion, immediately after caffeine infusion and 1, 2, 3, 4, and 6 hours (h) after dose completion; postdose values were compared with predose values. RESULTS A total of 41 infants with a mean GA of 29.2 ± 1.6 weeks and birth weight of 1,315 ± 257 g as well as postnatal age of 32.2 ± 10.8 hours were included in the study. rsSO2 significantly reduced from 63.1 to 57.5% immediately after caffeine infusion, 55.1% after 1 hour, and 55.2% after 2 hours with partial recovery at 3-hour postdose. sFTOE increased correspondingly. CONCLUSION Caffeine reduces splanchnic oxygenation and increases splanchnic oxygen extraction for at least 2 hours with partial recovery to predose levels at 3-hour postdose.
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Affiliation(s)
- Ozkan Ilhan
- Department of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Meltem Bor
- Department of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
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17
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Tran NN, Tran M, Lopez J, Ogbaa M, Votava-Smith JK, Brady KM. Near-Infrared Spectroscopy: Clinical Use in High-Risk Neonates. Neonatal Netw 2021; 40:73-79. [PMID: 33731373 DOI: 10.1891/0730-0832/11-t-678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Abstract
In this review, we describe the near-infrared spectroscopy (NIRS) technology and its clinical use in high-risk neonates in critical care settings. We searched databases (e.g., PubMed, Google Scholar, EBSCOhost) to find studies describing the use of NIRS on critically ill and high-risk neonates. Near-infrared spectroscopy provides continuous noninvasive monitoring of venous oxygen saturation. It uses technology similar to pulse oximetry to measure the oxygen saturation of hemoglobin in a tissue bed to describe the relative delivery and extraction of oxygen. Near-infrared spectroscopy can be a valuable bedside tool to provide clinicians indirect evidence of perfusion. It may prompt early interventions that promote oxygen delivery, which can improve high-risk neonatal outcomes.
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18
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Stienstra RM, McHoney M. Near-infrared spectroscopy (NIRS) measured tissue oxygenation in neonates with gastroschisis: a pilot study. J Matern Fetal Neonatal Med 2021; 35:5099-5107. [PMID: 33602021 DOI: 10.1080/14767058.2021.1875429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Management of gastroschisis involves either primary or staged closure. Bowel ischemia and abdominal compartment syndrome (ACS) are possible complications that can be related to a method of treatment. NIRS monitoring has never been applied in this group of patients and may allow for earlier detection of complications. OBJECTIVE To assess near-infrared spectroscopy (NIRS) monitoring in neonates with gastroschisis for detecting changes in tissue oxygenation (rSO2) related to bowel reductions or height of bowel in the silo and for detecting tissue ischemia. METHODS Patients with gastroschisis and controls underwent continuous multi-channel assessment of oxygenation of the brain (CrSO2), kidney (RrSO2) and bowel (GrSO2) in a prospective pilot study. RESULTS Fifteen neonates were treated with primary closure (n = 3) or staged closure (n = 12); two had confirmed bowel ischemia, none developed ACS.There was no significant correlation between height of the bowel and GrSO2 at apex (p = .72) or base (p = .54) within the silo. During staged reductions there was a clinically non-significant change in RrSO2 (Δ-2.5%, p = .04), but no significant changes in CrSO2 (p = .11), and GrSO2 of apex (p = .97) and base (p = .31). Patients with confirmed ischemia had GrSO2 that were lower than controls. CONCLUSIONS Measuring GrSO2 through a silo is feasible. Staged reduction seems safe based on NIRS measurements, with minimal effect of hydrostatic pressure on bowel oxygenation. NIRS was able to detect subtle changes in intra-abdominal renal perfusion during reduction and could differentiate healthy and ischemic bowel.
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Affiliation(s)
- Roxane M Stienstra
- University of Groningen, Groningen, the Netherlands.,Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Merrill McHoney
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland
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19
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Moschino L, Duci M, Fascetti Leon F, Bonadies L, Priante E, Baraldi E, Verlato G. Optimizing Nutritional Strategies to Prevent Necrotizing Enterocolitis and Growth Failure after Bowel Resection. Nutrients 2021; 13:nu13020340. [PMID: 33498880 PMCID: PMC7910892 DOI: 10.3390/nu13020340] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
Necrotizing enterocolitis (NEC), the first cause of short bowel syndrome (SBS) in the neonate, is a serious neonatal gastrointestinal disease with an incidence of up to 11% in preterm newborns less than 1500 g of birth weight. The rate of severe NEC requiring surgery remains high, and it is estimated between 20–50%. Newborns who develop SBS need prolonged parenteral nutrition (PN), experience nutrient deficiency, failure to thrive and are at risk of neurodevelopmental impairment. Prevention of NEC is therefore mandatory to avoid SBS and its associated morbidities. In this regard, nutritional practices seem to play a key role in early life. Individualized medical and surgical therapies, as well as intestinal rehabilitation programs, are fundamental in the achievement of enteral autonomy in infants with acquired SBS. In this descriptive review, we describe the most recent evidence on nutritional practices to prevent NEC, the available tools to early detect it, the surgical management to limit bowel resection and the best nutrition to sustain growth and intestinal function.
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MESH Headings
- Enterocolitis, Necrotizing/complications
- Enterocolitis, Necrotizing/diagnosis
- Enterocolitis, Necrotizing/prevention & control
- Enterocolitis, Necrotizing/surgery
- Failure to Thrive/prevention & control
- Humans
- Infant
- Infant Nutritional Physiological Phenomena
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/prevention & control
- Infant, Premature, Diseases/surgery
- Intestines/surgery
- Short Bowel Syndrome/etiology
- Short Bowel Syndrome/prevention & control
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Affiliation(s)
- Laura Moschino
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (L.M.); (L.B.); (E.P.); (E.B.)
| | - Miriam Duci
- Pediatric Surgery Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.D.); (F.F.L.)
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.D.); (F.F.L.)
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (L.M.); (L.B.); (E.P.); (E.B.)
| | - Elena Priante
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (L.M.); (L.B.); (E.P.); (E.B.)
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (L.M.); (L.B.); (E.P.); (E.B.)
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (L.M.); (L.B.); (E.P.); (E.B.)
- Correspondence: ; Tel.: +39-0498211428
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20
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Kılınç L, Türk HŞ, Sayın P, Çınar S, Demir M, İslamoğlu S. Effects of Pneumoperitoneum on Splanchnic Oxygenation during Abdominal Laparoscopic Surgery in Paediatric Patients: A prospective, Observational Study. Turk J Anaesthesiol Reanim 2020; 49:138-143. [PMID: 33997843 PMCID: PMC8098731 DOI: 10.5152/tjar.2020.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Pneumoperitoneum can cause disruption in splanchnic perfusion. This study aims to investigate effects of pneumoperitoneum on splanchnic oxygenation during abdominal laparoscopic surgery in paediatric patients with NIRS (Near-Infrared Spectroscopy). Material and methods A total of 45 patients between 1 and 4 years of age with ASA physical status I–II and scheduled to undergo abdominal laparoscopic surgery under general anaesthesia were enrolled in this prospective, observational surgery. No premedication was used. Standard monitoring and regional splanchnic saturation (rSPcO2), regional cerebral oxygen saturation (rScO2) with NIRS were established before anaesthesia. Anaesthesia was induced with an inhalational agent and maintained with an oxygen/air mixture and sevoflurane. Peripheral oxygen saturation (SPO2), rSPcO2, rScO2, heart rate (HR), mean arterial pressure (MAP), end tidal CO2 (Et-CO2), and insufflation pressure (IP) were continuously monitored during administration of anaesthesia and recorded. After intubation (baseline T0); before CO2 insufflation induced pneumoperitoneum (PP) (T1); CO2 PP insufflation (T2); 5 minutes after PP insufflation (T3); 10 minutes after PP insufflation (T4); 15 minutes after PP insufflation (T5); 20 minutes after PP insufflation (T6); 30 minutes after PP insufflation (T7), 60 minutes after PP insufflation (T8), and after desufflation (T9). Bradycardia and hypotension were recorded. Paracetamol IV 10 mg kg−1 was applied for post-operative analgesia. p<0.05 wasconsidered significant. Results HR, rScO2, and rSPcO2 decreased at all measured time intervals when compared to T0 (p<0.01) MAP decreased at T1 compared to T0 (p<0.001). Et-CO2 increased at T3-T4-T5-T6 compared to T0 (p<0.001). Conclusion We found that pneumoperitoneum reduced splanchnic oxygenation during laparoscopic abdominal surgery in paediatric patients, which was measured using NIRS.
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Affiliation(s)
- Leyla Kılınç
- Department Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Hacer Şebnem Türk
- Department Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Pınar Sayın
- Department Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Surhan Çınar
- Department Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mesut Demir
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Serkan İslamoğlu
- Department Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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21
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Goldshtrom N, Isler JR, Sahni R. Comparing liver and lower abdomen near-infrared spectroscopy in preterm infants. Early Hum Dev 2020; 151:105194. [PMID: 33017708 DOI: 10.1016/j.earlhumdev.2020.105194] [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: 03/05/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) is being increasingly used to investigate regional oxygenation (rSO2) and perfusion in areas such as the abdomen in preterm infants prone to feeding intolerance. Lower abdominal rSO2 values are extremely variable, high sensitivity and currently low specificity tools. The liver, a solid organ, could provide a more reliable site for splanchnic oxygenation and perfusion monitoring. AIMS Compare liver and lower abdomen rSO2 values in stable preterm infants in response to feeding. STUDY DESIGN We prospectively evaluated the correlation between rSO2 over the liver and lower abdomen in 16 preterm infants born between 28 and 32 weeks' gestational age using 48 h of continuous NIRS data. OUTCOME MEASURES Mean liver and lower abdomen rSO2 values. RESULTS The overall mean liver rSO2 were higher than the overall mean lower abdomen values, 78.4 ± 7.1 vs. 65.1 ± 24.9 respectively. Time series analysis showed a mean maximum cross correlation between the liver and lower abdomen of 0.28 (SD ± 0.03; p < 0.001); the liver signal lagged the lower abdomen by an average of 5.4 s (SD ± 1.2 s, Range 0-16 s). Mixed models analysis showed that during bolus feeding, liver values increased 10 to 30 min after the start of feeding (p < 0.01) while lower abdomen increased from 20 to 60 min after the start of feeding (p < 0.05) and liver values were less variable than lower abdomen values. CONCLUSION Liver rSO2 appears to be a more stable surrogate for splanchnic oxygenation and perfusion than lower abdomen rSO2.
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Affiliation(s)
- Nimrod Goldshtrom
- Department of Pediatrics, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
| | - Joseph R Isler
- Department of Pediatrics, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
| | - Rakesh Sahni
- Department of Pediatrics, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
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22
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Abnormal Splanchnic Regional Saturations in a Preterm Infant That Developed Necrotizing Enterocolitis Following a Red Blood Cell Transfusion. Adv Neonatal Care 2020; 20:401-405. [PMID: 32868590 DOI: 10.1097/anc.0000000000000711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) has been associated with red blood cell (RBC) transfusions in preterm infants. Near-infrared spectroscopy (NIRS) can be used to noninvasively monitor regional oxygen saturations (rSO2). CLINICAL FINDINGS This former 28-week female premature infant, 29 days old, received an RBC transfusion due to increased apneic spells and a hematocrit of 27%. Within 24 hours she developed abdominal distension and passed a bloody stool (Bell's stage 2 NEC on abdominal x-ray). She completed 7 days of antibiotics and nothing-by-mouth status and was discharged home on room air and oral feedings on day of life 70. PRIMARY DIAGNOSIS We describe the presentation of NEC following a RBC transfusion in a preterm infant monitored with cerebral and splanchnic NIRS. INTERVENTIONS Mean rSO2 (cerebral and splanchnic) measurements were continuously recorded and calculated in 30-minute periods at baseline (prior to packed RBC transfusion), every hour during the RBC transfusion, and every 3 hours for the following 48 hours. OUTCOMES In this infant, average baseline splanchnic rSO2 was low at 46.5%, and increased during transfusion to 65%. However, following the RBC transfusion and an enteral feeding, splanchnic rSO2 dramatically decreased to 26%, and remained low until the time of NEC diagnosis. PRACTICE RECOMMENDATIONS To develop awareness of the increased risk for NEC in premature infants with significant anemia that receive packed RBC transfusions. With further studies and education, NIRS could be a valuable tool for the nurses and medical team to identify these at-risk neonates.
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Intestinal Oxygenation and Survival After Surgery for Necrotizing Enterocolitis: An Observational Cohort Study. Ann Surg 2020; 275:e503-e510. [PMID: 32324690 DOI: 10.1097/sla.0000000000003913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether regional intestinal oxygen saturation (rintSO2) and regional cerebral oxygen saturation (rcSO2) measurements aid in estimating survival of preterm infants after surgery for NEC. SUMMARY OF BACKGROUND DATA Predicting survival after surgery for NEC is difficult yet of the utmost importance for counseling parents. METHODS We retrospectively studied prospectively collected data of preterm infants with surgical NEC who had available rintSO2 and rcSO2 values measured via near-infrared spectroscopy 0-24 hours preoperatively. We calculated mean rintSO2 and rcSO2 for 60-120 minutes for each infant. We analyzed whether preoperative rintSO2 and rcSO2 differed between survivors and non-survivors, determined cut-off points, and assessed the added value to clinical variables. RESULTS We included 22 infants, median gestational age 26.9 weeks [interquartile range (IQR): 26.3-28.4], median birth weight 1088 g [IQR: 730-1178]. Eleven infants died postoperatively. Preoperative rintSO2, but not rcSO2, was higher in survivors than in non-survivors [median: 63% (IQR: 42-68) vs 29% (IQR: 21-43), P < 0.01), with odds ratio for survival 4.1 (95% confidence interval, 1.2-13.9, P = 0.02) per 10% higher rintSO2. All infants with rintSO2 values of >53% survived, whereas all infants with rintSO2 <35% died. Median C-reactive protein [138 mg/L (IQR: 83-179) vs 73 mg/L (IQR: 12-98), P < 0.01), lactate [1.1 mmol/L (IQR: 1.0-1.6) vs 4.6 mmol/L (IQR: 2.8-8.0), P < 0.01], and fraction of inspired oxygen [25% (IQR: 21-31) vs 42% (IQR: 30-80), P < 0.01] differed between survivors and non-survivors. Only rintSO2 remained significant in the multiple regression model. CONCLUSIONS Measuring rintSO2, but not rcSO2, seems of added value to clinical variables in estimating survival of preterm infants after surgery for NEC. This may help clinicians in deciding whether surgery is feasible and to better counsel parents about their infants' chances of survival.
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Predicting intestinal recovery after necrotizing enterocolitis in preterm infants. Pediatr Res 2020; 87:903-909. [PMID: 31649338 DOI: 10.1038/s41390-019-0634-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intestinal recovery after NEC is difficult to predict in individuals. We evaluated whether several biomarkers predict intestinal recovery after NEC in preterm infants. METHODS We measured intestinal tissue oxygen saturation (rintSO2) and collected urinary intestinal-fatty acid binding protein (I-FABPu) levels 0-24 h and 24-48 h after NEC onset, and before and after the first re-feed. We assessed intestinal recovery in two ways: time to full enteral feeding (FEFt; below or equal/above group's median) and development of post-NEC complications (recurrent NEC/post-NEC stricture). We determined whether the rintSO2, its range, and I-FABPu differed between groups. RESULTS We included 27 preterm infants who survived NEC (Bell's stage ≥ 2). Median FEFt was 14 [IQR: 12-23] days. Biomarkers only predicted intestinal recovery after the first re-feed. Mean rintSO2 ≥ 53% combined with mean rintSO2range ≥ 50% predicted FEFt < 14 days with OR 16.7 (CI: 2.3-122.2). The rintSO2range was smaller (33% vs. 51%, p < 0.01) and I-FABPu was higher (92.4 vs. 25.5 ng/mL, p = 0.03) in case of post-NEC stricture, but not different in case of recurrent NEC, compared with infants without complications. CONCLUSION The rintSO2, its range, and I-FABPu after the first re-feed after NEC predicted intestinal recovery. These biomarkers have potential value in individualizing feeding regimens after NEC.
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Seager E, Longley C, Aladangady N, Banerjee J. Measurement of gut oxygenation in the neonatal population using near-infrared spectroscopy: a clinical tool? Arch Dis Child Fetal Neonatal Ed 2020; 105:76-86. [PMID: 31154420 DOI: 10.1136/archdischild-2018-316750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/04/2022]
Abstract
CONTEXT Near-infrared spectroscopy (NIRS) is a non-invasive bedside monitor of tissue oxygenation that may be a useful clinical tool in monitoring of gut oxygenation in newborn infants. OBJECTIVE To systematically review literature to determine whether NIRS is a reliable tool to monitor gut oxygenation on neonatal units. DATA SOURCES PubMed and Embase databases were searched using the terms 'neonate', 'preterm infants', 'NIRS' and 'gut oxygenation' (2001-2018). STUDY SELECTION Studies were included if they met inclusion criteria (clinical trial, observational studies, neonatal population, articles in English and reviewing regional gut oxygen saturations) and exclusion criteria (not evaluating abdominal NIRS or regional oxygen saturations). DATA EXTRACTION Two authors independently searched PubMed and Embase using the predefined terms, appraised study quality and extracted from 30 studies the study design and outcome data. LIMITATIONS Potential for publication bias, majority of studies were prospective cohort studies and small sample sizes. RESULTS Thirty studies were reviewed assessing the validity of abdominal NIRS and potential application in neonates. Studies reviewed assessed abdominal NIRS in different settings including normal neonates, bolus and continuous feeding, during feed intolerance, necrotising enterocolitis and transfusion with packed red cells. Several observational studies demonstrated how NIRS could be used in clinical practice. CONCLUSIONS NIRS may prove to be a useful bedside tool on the neonatal unit, working alongside current clinical tools in the monitoring of newborn infants (preterm and term) and inform clinical management. We recommend further studies including randomised controlled trials looking at specific measurements and cut-offs for abdominal NIRS for use in further clinical practice.
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Affiliation(s)
- Emilie Seager
- Paediatrics and Neonatal, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Longley
- Paediatrics and Neonatal, Imperial College Healthcare NHS Trust, London, UK
| | | | - Jayanta Banerjee
- Neonatology, Imperial College Healthcare NHS Trust, London, UK.,Imperial College London Institute of Clinical Sciences, London, UK
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Pavlek LR, Mueller C, Jebbia MR, Kielt MJ, Fathi O. Near-Infrared Spectroscopy in Extremely Preterm Infants. Front Pediatr 2020; 8:624113. [PMID: 33553078 PMCID: PMC7859523 DOI: 10.3389/fped.2020.624113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/23/2020] [Indexed: 01/18/2023] Open
Abstract
With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22-24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.
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Affiliation(s)
- Leeann R Pavlek
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Clifford Mueller
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Maria R Jebbia
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Matthew J Kielt
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Omid Fathi
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
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Jiang Y, Wei J, Zhang H, Ewart S, Rezwan FI, Holloway JW, Arshad H, Karmaus W. Epigenome wide comparison of DNA methylation profile between paired umbilical cord blood and neonatal blood on Guthrie cards. Epigenetics 2019; 15:454-461. [PMID: 31818188 DOI: 10.1080/15592294.2019.1699983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
DNA methylation (DNAm) in blood (umbilical cord blood and capillary blood collected after birth on Guthrie cards) during the perinatal period is being increasingly studied with the aim of identifying epigenetic markers of in utero environmental exposures or later disease development. However, the comparability in DNAm between these two sources is unknown. To this end, DNAm from the cord blood and capillary blood of 34 subjects in the Isle of Wight 3rd Generation Birth Cohort (68 samples) were included to assess the comparability. Differences in average DNAm (overall agreement), correlations in DNAm, and intra-class correlation coefficients (ICC) in DNAm between the two sources, at each of the 430,742 CpG sites, were evaluated. The results showed that a high proportion (70.1%) of the CpGs DNAm agreed between cord blood and neonatal blood on Guthrie cards. A small portion of CpGs showed high correlation (correlation ≥0.5) or high ICC (ICC ≥0.5) in DNAm of the whole genome. This proportion increased dramatically in differentially methylated regions (DMRs) that are associated with exposure to maternal smoking, between the two sources.
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Affiliation(s)
- Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Jinfeng Wei
- College of Arts and Sciences, Maryville University, St. Louis, MO, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Susan Ewart
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
| | - Faisal I Rezwan
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hasan Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Kuik SJ, van Zoonen AGJF, Bos AF, Van Braeckel KNJA, Hulscher JBF, Kooi EMW. The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study. BMC Pediatr 2019; 19:404. [PMID: 31684920 PMCID: PMC6827212 DOI: 10.1186/s12887-019-1805-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background The factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rintSO2) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rintSO2 affected cerebral oxygen saturation (rcSO2). Methods In a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rcSO2, we also used logistic regression analyses. Results We included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially. Conclusions Our study suggests that postprandial rintSO2 increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands. Trial registration For this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.
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Affiliation(s)
- Sara J Kuik
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
| | - Anne G J F van Zoonen
- University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
| | - Koenraad N J A Van Braeckel
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
| | - Jan B F Hulscher
- University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands
| | - Elisabeth M W Kooi
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
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Regional tissue oxygenation monitoring in the neonatal intensive care unit: evidence for clinical strategies and future directions. Pediatr Res 2019; 86:296-304. [PMID: 31247635 DOI: 10.1038/s41390-019-0466-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 12/19/2022]
Abstract
Near-infrared spectroscopy (NIRS)-based monitoring of regional tissue oxygenation (rSO2) is becoming more commonplace in the neonatal intensive care unit (NICU). While increasing evidence supports rSO2 monitoring, actual standards for applying this noninvasive bedside technique continue to evolve. This review highlights the current strengths and pitfalls surrounding practical NIRS-based monitoring in the neonatal population. The physiologic background of rSO2 monitoring is discussed, with attention to understanding oxygen delivery/consumption mismatch and its effects on tissue oxygen extraction. The bedside utility of both cerebral and peripheral rSO2 monitoring in the NICU is then explored from two perspectives: (1) disease/event-specific "responsive" monitoring and (2) "routine," continuous monitoring. Recent evidence incorporating both monitoring approaches is summarized with emphasis on practical applicability in the NICU. Finally, a future paradigm for a broad-based NIRS monitoring strategy is presented, with attention towards improving personalization of neonatal care and ultimately enhancing long-term outcomes.
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30
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Arman D, Sancak S, Gürsoy T, Topcuoğlu S, Karatekin G, Ovalı F. The association between NIRS and Doppler ultrasonography in preterm infants with patent ductus arteriosus. J Matern Fetal Neonatal Med 2019; 33:1245-1252. [PMID: 31307253 DOI: 10.1080/14767058.2019.1639661] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To determine if near-infrared spectroscopy (NIRS), which is easier to obtain than Doppler ultrasonography (USG), may be used in accordance with Doppler USG to provide additional data for assessment of organ blood flow velocities in preterm infants with hemodynamically significant PDA.Study design: Thirty-one infants who were treated with ibuprofen for closure of PDA were monitored continuously with NIRS. Cerebral, mesenteric, and renal arterial blood flow velocities were measured with Doppler USG before and after the treatment.Results: While cerebral, mesenteric, and renal fractional oxygen extraction (FTOE) measurements decreased significantly (p = .042, p < .001, p < .001, respectively), NIRS measurements (p = .016, p < .001, p < .001, respectively) and mean blood flow velocities (p = .003, p = .011, p = .002, respectively) increased significantly after the treatment. There was a significant correlation between pretreatment cerebral and mesenteric FTOE and resistive index (RI) values (r = 0.45, p = .01, and r = 0.46, p = .01, respectively). However, no correlation was observed between renal FTOE values and renal RI (r = 0.33, p = .06). Posttreatment cerebral, renal, and mesenteric FTOE values correlated positively with corresponding RI (r = 0.41, p = .02; r = 0.39, p = .02; r = 0.65, p < 01; respectively). Pretreatment and posttreatment cerebral, mesenteric, and renal FTOE values and arterial mean velocities were inversely correlated (pretreatment: r = 0.69, p < .01; r = 0.72, p < .01; r = 0.77, p < .01; posttreatment: r = 0.54, p = .01; r = 0.69, p < .01; r = 0.38, p = .01; respectively).Conclusion: As Doppler and NIRS measurements correlated significantly, we concluded that NIRS might be used in monitoring organ blood flow in preterm infants with PDA, which may provide additional data for management of this condition.
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Affiliation(s)
- Didem Arman
- Department of Neonatal Intensive Care, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
| | - Selim Sancak
- Department of Neonatal Intensive Care, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
| | - Tugba Gürsoy
- Department of Neonatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Sevilay Topcuoğlu
- Department of Neonatal Intensive Care, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
| | - Güner Karatekin
- Department of Neonatal Intensive Care, Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey
| | - Fahri Ovalı
- Department of Pediatrics, Neonatal Intensive Care Unit, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
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Splanchnic NIRS monitoring in neonatal care: rationale, current applications and future perspectives. J Perinatol 2018; 38:431-443. [PMID: 29472709 DOI: 10.1038/s41372-018-0075-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022]
Abstract
Near infrared spectroscopy (NIRS) provides a non-invasive, continuous monitoring of regional tissue oxygenation. NIRS assessment of neonatal splanchnic oxygenation (SrSO2) has gained increasing interest over the last decade, as local hypoxia and ischemia underlie the most feared gut complications in neonates. Current literature provides encouraging evidence in support of SrSO2 reliability in detecting mesenteric hemodynamic changes related to various physiological and pathological conditions in-term and preterm infants. Even so, while splanchnic NIRS monitoring looks promising for investigating gut physiopathology in research settings, further studies are needed to evaluate its feasibility as a routine monitoring tool in neonatal care and to investigate its potential role in clinical decision making. After a brief introduction to NIRS technical principles, this review aims to provide a complete overview of current neonatal applications for splanchnic NIRS monitoring, to discuss its possible limitations and to suggest future directions for research and clinical applications.
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Abstract
PURPOSE OF REVIEW There has been a significant increase in the utilization of NIRS in neonatal care over the last few years, with some centers now routinely utilizing this monitoring technique for direct intervention at the bedside. In this review, we provide a summary of the most up-to-date evidence on near infrared spectroscopy utilization, with particular emphasis on measurement of cerebral oxygenation in preterm infants. RECENT FINDINGS There have been significant advances in the technology, leading to an increase in the number of available devices and in the use of this monitoring tool to reduce cerebral injury in preterm infants. The role of NIRS in assessing cerebral autoregulation in preterm and term infants, in evaluating somatic oxygenation, and in the management of newborns with hypoxic ischaemic encephalopathy is discussed. SUMMARY Two recent pilot randomized controlled trials highlight the potential of cerebral oxygenation monitoring to direct management in the delivery room and the neonatal intensive care unit. However, we urge caution against routine use and await the results of further studies in this area before considering this type of monitoring as standard of care.
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Marulli A, Kamlin COF, Dawson JA, Donath SM, Davis PG, Lorenz L. The effect of skin-to-skin care on cerebral oxygenation during nasogastric feeding of preterm infants. Acta Paediatr 2018; 107:430-435. [PMID: 29168250 DOI: 10.1111/apa.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 11/28/2022]
Abstract
AIM To describe cerebral oxygenation during gavage feeding of preterm infants during incubator and skin-to-skin care. METHODS Further analysis of data from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin-to-skin care with incubator care. Data were analysed in three epochs; 10 minutes prefeed, during-feed and 10 minutes postfeed. Measurements from infants fed during incubator care were compared with those obtained during skin-to-skin care. RESULTS In 39 infants [median (IQR) 27.8 (26.1-30.0) weeks' gestation], there was no difference in cerebral oxygenation between pre-, during- and postfeed. Heart rate increased by three beats per minute postfeed compared with during-feed. Twenty infants received two gavage feeds, one feed in the incubator and another during skin-to-skin care. There was no difference in cerebral oxygenation and heart rate; peripheral oxygen saturation decreased by 3% during feeding whilst skin-to-skin care compared with feeding in the incubator. CONCLUSION Cerebral oxygenation remained stable before, during and after gavage feeding in an incubator and during skin-to-skin care. The small decrease in oxygen saturation whilst receiving gavage feeding during skin-to-skin care is unlikely to be clinically important, providing reassurance that preterm infants maintain physiological stability during skin-to-skin care.
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Affiliation(s)
- A Marulli
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - COF Kamlin
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - JA Dawson
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - SM Donath
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - PG Davis
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - L Lorenz
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- Department of Neonatology; University Children's Hospital of Tübingen; Tübingen Germany
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Grometto A, Pizzo B, Strozzi MC, Gazzolo F, Gazzolo D. Near-infrared spectroscopy is a promising noninvasive technique for monitoring the effects of feeding regimens on the cerebral and splanchnic regions. Acta Paediatr 2018; 107:234-239. [PMID: 28960522 DOI: 10.1111/apa.14099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/29/2017] [Accepted: 09/22/2017] [Indexed: 11/24/2022]
Abstract
AIM The effects of different milk and, or, administration regimens on cerebro-splanchnic perfusion are still a matter of debate. We investigated the effects of the bolus administration of breast milk or formula on cerebro-splanchnic oximetry, function and perfusion, assessed by near-infrared spectroscopy (NIRS). METHODS This observational study of 30 infants fed with breast (n = 15) or formula (n = 15) milk, and matched for gestational age and birth weight, was carried out in the neonatal intensive care unit of the C Arrigo Children's Hospital, Alessandria, Italy, a tertiary-level referral centre, from October 2015 to December 2016. NIRS monitoring parameters, such as cerebral and splanchnic oximetry, fraction of tissue oxygen extraction and the cerebral-splanchnic ratio, were recorded before, during and after feeding. RESULTS Breast milk led to a significant increase in cerebro-splanchnic oximetry and tissue oxygen extraction (p < 0.001) during and after feeding, and the cerebro-splanchnic perfusion ratio was significantly higher (p < 0.001) in the breast than formula group. CONCLUSION Our study results suggest that breast milk was better tolerated than formula, requiring lower energy expenditure and lower cerebro-splanchnic haemodynamic redistribution. The findings could prompt investigations using NIRS as a promising noninvasive tool for cerebral and splanchnic longitudinal monitoring during neonatal feeding.
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Affiliation(s)
- Alice Grometto
- Faculty of Biology; University of Pavia; Pavia Italy
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
| | - Benedetta Pizzo
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
- Faculty of Biology; University of Oriental Piedmont; Alessandria Italy
| | - Maria Chiara Strozzi
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
| | - Francesca Gazzolo
- Faculty of Biology; University of Oriental Piedmont; Alessandria Italy
| | - Diego Gazzolo
- Department of Maternal, Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria Italy
- Neonatal Intensive Care Unit G. d'Annunzio University of Chieti; Chieti Italy
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Braski K, Weaver-Lewis K, Loertscher M, Ding Q, Sheng X, Baserga M. Splanchnic-Cerebral Oxygenation Ratio Decreases during Enteral Feedings in Anemic Preterm Infants: Observations under Near-Infrared Spectroscopy. Neonatology 2017; 113:75-80. [PMID: 29131125 PMCID: PMC5734057 DOI: 10.1159/000481396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anemia is common in premature infants. Due to risks with red blood cell transfusions, many anemic infants are not transfused. The implications of this pathophysiologic status, especially at times of increased metabolic demand (enteral feedings), is not well understood. Near-infrared spectroscopy (NIRS) allows for the noninvasive determination of regional oxygen saturations (rSO2) in tissues such as the brain and mesentery, giving insight into their oxygen sufficiency. OBJECTIVE We tested the hypothesis that during enteral feedings very low birth weight (VLBW) infants with a hematocrit ≤28% will experience a decrease in splanchnic rSO2 and splanchnic-cerebral oxygenation ratio (SCOR). METHODS This prospective, observational, 2-centered study included VLBW infants receiving full enteral feedings with a hematocrit ≤28%. Cerebral and splanchnic rSO2 were monitored via NIRS for 24 h. Average values were calculated for periods immediately preceding, during, and after each feeding. SCOR was calculated from these values (rSO2 splanchnic/rSO2 cerebral), and data were analyzed using a linear mixed effect model. RESULTS Fifty neonates with a median gestational age of 28 weeks (range 23-32), a birth weight of 1,118 ± 284 g (mean ± SD), and a hematocrit of 26 ± 2% (mean ± SD) were studied. During feedings, SCOR decreased significantly from baseline (0.72 ± 0.17 to 0.69 ± 0.17, p = 0.043). With feedings, there was a trend of decreased splanchnic rSO2 (47 ± 11 to 45 ± 10, p = 0.057) and no change in cerebral rSO2 (66 ± 8 to 66 ± 7, p = 0.597). CONCLUSIONS VLBW infants with a hematocrit ≤28% had a decrease in SCOR and a trend towards decreased splanchnic rSO2 with enteral feedings.
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Affiliation(s)
- Katherine Braski
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kimberlee Weaver-Lewis
- Women’s and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Manndi Loertscher
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Qian Ding
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah USA
| | - Xiaoming Sheng
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mariana Baserga
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Assessment of Mesenteric Tissue Saturation, Oxygen Saturation, and Heart Rate Pre- and Post-Blood Transfusion in Very Low-Birth-Weight Infants Using Abdominal Site Near-Infrared Spectroscopy. Adv Neonatal Care 2017; 17:E3-E9. [PMID: 28787302 DOI: 10.1097/anc.0000000000000417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm infants often receive blood transfusions during hospitalization. Although transfusions are intended to enhance oxygen delivery, previous studies found decreases in tissue and mesenteric oxygen saturation during and after blood transfusions without changes in vital signs and hemoglobin oxygen saturation. PURPOSE To study the effect of blood transfusions on regional mesenteric tissue oxygen saturation (rSO2), hemoglobin saturation of oxygen (SpO2), and heart rate (HR) in premature infants. METHOD A prospective, observational, nonrandomized study using a repeated-measures design was done to evaluate changes in physiologic variables (HR, SpO2, rSO2) before, during, and after a blood transfusion in premature infants. RESULTS A convenience sample of 30 infants with a mean gestational age of 25.5 (2.1) weeks was recruited. Repeated-measures analysis of variance found no significant differences in HR (P = .06) and SpO2 (P = .55) over time. However, significant differences occurred in rSO2 over the 3 time periods (P < .001). The rSO2 increased during the transfusion from 40.3% to 41.5%, but decreased to 34.9% in the posttransfusion period. Pairwise comparisons revealed statistically significant mean rSO2 differences between pretransfusion and posttransfusion (P < .001), and during transfusion to posttransfusion (P < .001) periods. IMPLICATIONS FOR RESEARCH This study supports previous findings of perfusion changes during blood transfusions in preterm infants. IMPLICATIONS FOR PRACTICE Measuring mesenteric tissue oxygenation during blood transfusion in very low-birth-weight infants can potentially add another physiologic parameter to guide further clinical assessment and interventions during transfusions.
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Kocvarova L, Mackovicova L, Matasova K, Zibolen M. The early postnatal blood flow characteristics in the superior mesenteric and coeliac arteries in late preterm neonates. J Matern Fetal Neonatal Med 2017; 31:3027-3032. [PMID: 28760069 DOI: 10.1080/14767058.2017.1362553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Lenka Kocvarova
- Jessenius Faculty of Medicine in Martin, Clinic of Neonatology, Comenius University, Bratislava, Slovakia
| | - Lenka Mackovicova
- Institute of Mathematics and Informatics, Matej Bel University, Banska Bystrica, Slovakia
| | - Katarina Matasova
- Jessenius Faculty of Medicine in Martin, Clinic of Neonatology, Comenius University, Bratislava, Slovakia
| | - Mirko Zibolen
- Jessenius Faculty of Medicine in Martin, Clinic of Neonatology, Comenius University, Bratislava, Slovakia
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Schat TE, Heida FH, Schurink M, van der Laan ME, Hulzebos CV, Bos AF, Kooi EMW, Hulscher JBF. The relation between splanchnic ischaemia and intestinal damage in necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 2016; 101:F533-F539. [PMID: 27048432 DOI: 10.1136/archdischild-2015-309838] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 02/23/2016] [Accepted: 03/14/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The underlying pathophysiology of necrotising enterocolitis (NEC) remains incompletely understood, particularly the role of intestinal perfusion. We aimed to determine the relation between cerebral and splanchnic fractional tissue oxygen extraction (FTOE), a marker for tissue underperfusion, with intestinal fatty acid-binding protein in plasma (I-FABPp), a marker for intestinal damage, in infants with NEC. Furthermore, we investigated the combined courses of cerebral and splanchnic FTOE values and I-FABPp levels in uncomplicated (conservative treatment) and complicated NEC (surgery or death). DESIGN This study was part of a prospective observational cohort study. PATIENTS We included 19 preterm infants with NEC (9 uncomplicated, 10 complicated). INTERVENTIONS Using near-infrared spectroscopy, we measured regional cerebral and splanchnic tissue oxygen saturations continuously for 48 h after NEC onset. We measured I-FABPp levels simultaneously. MAIN OUTCOME MEASURES We used Spearman correlation tests to calculate correlation coefficients between FTOE values and I-FABPp levels in uncomplicated and complicated NEC. RESULTS Median (range) gestational age was 28 (25-36) weeks and median (range) birth weight was 1290 (740-2400) g. Cerebral and splanchnic FTOE values correlated strongly with I-FABPp levels (rho between .745 and 0.900; p<0.001-0.037) during the first 16 h after NEC onset. Thereafter, in uncomplicated NEC, splanchnic FTOE values increased while I-FABPp levels decreased concomitantly. In complicated NEC both splanchnic FTOE values and I-FABPp levels decreased. CONCLUSIONS Combining cerebral and splanchnic FTOE values with I-FABPp levels, gives insight in the pathological chain of events resulting in progression or recovery of intestinal ischaemia in NEC. TRIAL REGISTRATION NUMBER NTR3239.
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Affiliation(s)
- Trijntje E Schat
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Fardou H Heida
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten Schurink
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michelle E van der Laan
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Jan B F Hulscher
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bozzetti V, Paterlini G, De Lorenzo P, Gazzolo D, Valsecchi MG, Tagliabue PE. Impact of Continuous vs Bolus Feeding on Splanchnic Perfusion in Very Low Birth Weight Infants: A Randomized Trial. J Pediatr 2016; 176:86-92.e2. [PMID: 27339251 DOI: 10.1016/j.jpeds.2016.05.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/30/2016] [Accepted: 05/10/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To detect changes in splanchnic perfusion and oxygenation induced by 2 different feeding regimens in infants with intrauterine growth restriction (IUGR) and those without IUGR. STUDY DESIGN This was a randomized trial in 40 very low birth weight infants. When an enteral intake of 100 mL/kg/day was achieved, patients with IUGR and those without IUGR were randomized into 2 groups. Group A (n = 20) received a feed by bolus (in 10 minutes), then, after at least 3 hours, received the same amount of formula by continuous nutrition over 3 hours. Group B (n = 20) received a feed administered continuously over 3 hours, followed by a bolus administration (in 10 minutes) of the same amount of formula after at least 3 hours. On the day of randomization, intestinal and cerebral regional oximetry was measured via near-infrared spectroscopy and Doppler ultrasound (US) of the superior mesenteric artery was performed. Examinations were performed before the feed and at 30 minutes after the feed by bolus and before the feed, at 30 minutes after the start of the feed, and at 30 minutes after the end of the feed for the 3-hour continuous feed. RESULTS Superior mesenteric artery Doppler US showed significantly higher perfusion values after the bolus feeds than after the continuous feeds. Near-infrared spectroscopy values remained stable before and after feeds. Infants with IUGR and those without IUGR showed the same perfusion and oxygenation patterns. CONCLUSION According to our Doppler US results, bolus feeding is more effective than continuous feeding in increasing splanchnic perfusion. TRIAL REGISTRATION ClinicalTrials.gov: NCT01341236.
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Affiliation(s)
- Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy.
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Paola De Lorenzo
- Department of Pediatrics, Centro Ricerca Tettamanti, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Diego Gazzolo
- Department of Maternal, Fetal, and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo E Tagliabue
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
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40
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Bailey SM, Mally PV. Review of splanchnic oximetry in clinical medicine. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:091306. [PMID: 27165703 DOI: 10.1117/1.jbo.21.9.091306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
Global tissue perfusion and oxygenation are important indicators of physiologic function in humans. The monitoring of splanchnic oximetry through the use of near-infrared spectroscopy (NIRS) is an emerging method used to assess tissue oxygenation status. Splanchnic tissue oxygenation (SrSO2) is thought to be potentially of high value in critically ill patients because gastrointestinal organs can often be the first to suffer ischemic injury. During conditions of hypovolemia, cardiac dysfunction, or decreased oxygen-carrying capacity, blood flow is diverted toward vital organs, such as the brain and the heart at the expense of the splanchnic circulation. While monitoring SrSO2 has great potential benefit, there are limitations to the technology and techniques. SrSO2 has been found to have a relatively high degree of variability that can potentially make it difficult to interpret. In addition, because splanchnic organs only lie near the skin surface in children and infants, and energy from currently available sensors only penetrates a few centimeters deep, it can be difficult to use clinically in a noninvasive manner in adults. Research thus far is showing that splanchnic oximetry holds great promise in the ability to monitor patient oxygenation status and detect disease states in humans, especially in pediatric populations.
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Akotia DH, Durham JT, Arnell KM, Petruzzelli DL, Katheria AC. Relationship Between Near-Infrared Spectroscopy and Transabdominal Ultrasonography: Noninvasive Monitoring of Intestinal Function in Neonates. Med Sci Monit 2016; 22:61-8. [PMID: 26736134 PMCID: PMC4708098 DOI: 10.12659/msm.895730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) has the potential to continuously and noninvasively monitor intestinal function. This technology may be valuable because among neonates, intestinal maturity is highly variable and difficult to assess based solely on clinical signs. The aim of this study was to determine if there is an association between NIRS-based StO2 measurements and peristaltic activity assessed by transabdominal ultrasonography (US). MATERIAL/METHODS Nineteen neonates of gestational age >32 weeks were categorized according to "no/low" versus "normal/hyperactive" motility levels, based on blinded US scan results. StO2 was recorded every 2 s for 24 h, following the ultrasound recording. Differences between the resulting estimates of average StO2 (bias of fits) and goodness-of-fit (residuals) were evaluated. RESULTS Newborns with normal/hyperactive motility had higher mean StO2 than newborns with no/low motility (72.3±4.4 vs. 65.5±7.9, p<0.05, F=5.65). Residual errors were not significantly different between the 2 groups (p=0.213, F=0.213). A multivariate linear regression model using the means, residuals, and pairwise products of both, demonstrated more significant separation (0.47±0.26 vs. -0.24±0.33, p<0.01, F=27.4). A non-linear variant of the multivariate linear regression model demonstrated greatest separation (0.68±0.24 vs. -0.49±0.53, p<0.01, F=41.9). CONCLUSIONS This is the first study to demonstrate an association between NIRS-based StO2 measurements and peristaltic activity visualized by ultrasound imaging. NIRS may offer a continuous, noninvasive method to assess motility. This may have significant implications in premature infants at risk for feeding intolerance or necrotizing enterocolitis.
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Affiliation(s)
- Devang H Akotia
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Jayson T Durham
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Kathy M Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Deborah L Petruzzelli
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
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Itoh H, Ichiba S, Ujike Y, Douguchi T, Obata H, Inamori S, Iwasaki T, Kasahara S, Sano S, Ündar A. Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure. Artif Organs 2015; 40:19-26. [PMID: 26526784 DOI: 10.1111/aor.12588] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to compare the effects of pulsatile and nonpulsatile extracorporeal membrane oxygenation (ECMO) on hemodynamic energy and systemic microcirculation in an acute cardiac failure model in piglets. Fourteen piglets with a mean body weight of 6.08 ± 0.86 kg were divided into pulsatile (N = 7) and nonpulsatile (N = 7) ECMO groups. The experimental ECMO circuit consisted of a centrifugal pump, a membrane oxygenator, and a pneumatic pulsatile flow generator system developed in-house. Nonpulsatile ECMO was initiated at a flow rate of 140 mL/kg/min for the first 30 min with normal heart beating, with rectal temperature maintained at 36°C. Ventricular fibrillation was then induced with a 3.5-V alternating current to generate a cardiac dysfunction model. Using this model, we collected the data on pulsatile and nonpulsatile groups. The piglets were weaned off ECMO at the end of the experiment (180 min after ECMO was initiated). The animals did not receive blood transfusions, inotropic drugs, or vasoactive drugs. Blood samples were collected to measure hemoglobin, methemoglobin, blood gases, electrolytes, and lactic acid levels. Hemodynamic energy was calculated using the Shepard's energy equivalent pressure. Near-infrared spectroscopy was used to monitor brain and kidney perfusion. The pulsatile ECMO group had a higher atrial pressure (systolic and mean), and significantly higher regional saturation at the brain level, than the nonpulsatile group (for both, P < 0.05). Additionally, the pulsatile ECMO group had higher methemoglobin levels within the normal range than the nonpulsatile group. Our study demonstrated that pulsatile ECMO produces significantly higher hemodynamic energy and improves systemic microcirculation, compared with nonpulsatile ECMO in acute cardiac failure.
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Affiliation(s)
- Hideshi Itoh
- Department of Medical Engineering, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan.,Departments of, Emergency and Critical Care Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shingo Ichiba
- Community and Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihito Ujike
- Departments of, Emergency and Critical Care Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuma Douguchi
- Department of, Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Hideaki Obata
- Biomedical Engineering, Okayama University of Science, Okayama, Japan
| | - Syuji Inamori
- Department of Medical Engineering, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan
| | - Tatsuo Iwasaki
- Anesthesiology, Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of, Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Shunji Sano
- Department of, Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Akif Ündar
- Departments of Pediatrics, Surgery, and Bioengineering, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA
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Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry. Am J Emerg Med 2015; 33:344-8. [DOI: 10.1016/j.ajem.2014.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/19/2014] [Accepted: 11/21/2014] [Indexed: 11/18/2022] Open
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Pitzele A, Rahimi M, Armbrecht E, Havranek T. Packed red blood cell transfusion (PRBC) attenuates intestinal blood flow responses to feedings in pre-term neonates with normalization at 24 hours. J Matern Fetal Neonatal Med 2014; 28:1770-3. [PMID: 25269406 DOI: 10.3109/14767058.2014.971746] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether packed red blood cell (PRBC) transfusion affects post-prandial superior mesenteric artery blood flow velocities (SMA BFVs) in very-low birth weight (VLBW) neonates and if so, at what time point after transfusion restoration of previous SMA BFV patterns occurs. DESIGN/METHODS VLBW pre-term neonates, older than 14 days and tolerating bolus enteral feedings administered every 3 h were enrolled in this prospective observational study. Pulsed Doppler ultrasound was used to measure pre- and post-prandial (at 45 min) time-averaged mean, peak and end diastolic velocities (TAMV, PSV, EDV) immediately before and after 15 ml/kg of PRBC transfusion was given over 3 h; patent ductus arteriosus (PDA) status was also evaluated. Subsequent pre- and post-prandial SMA BFVs were recorded 24 and 48 h after the transfusion. RESULTS Pre- and post-prandial measurements were obtained for 21 out of 25 enrolled infants. Post-prandial SMA BFVs were attenuated during the feedings immediately after transfusion; at 24 and 48 h after transfusion, changes in post-prandial SMA BFVs were similar to those measured prior to transfusion; the presence of the PDA did not affect results. CONCLUSIONS PRBC transfusion blunted SMA BFV responses to feedings immediately after the transfusion with normalization observed 24 h post-transfusion.
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Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr Res 2014; 76:81-5. [PMID: 24713819 DOI: 10.1038/pr.2014.52] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/14/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However, there is no clear evidence regarding which method is better tolerated. We investigated the differences between bolus and continuous feeding in terms of cerebral and splanchnic oxygenation in healthy preterm infants. METHODS Thirty preterm infants underwent a simultaneous 6-h near-infrared-spectroscopy monitoring of cerebral and splanchnic oxygenation, during which they were fed twice through an orogastric tube: one meal was given as a 10-min bolus, and the other was given continuously over a period of 3 h. Oxygenation trends over time were evaluated and compared between bolus and continuous feeding modes. RESULTS Cerebral oxygenation did not change over time and did not differ between the two feeding techniques. Splanchnic oxygenation changed significantly over time and differed between the two feeding techniques, with a significant increase after bolus feeding and a remarkable reduction during continuous feeding. CONCLUSION Bolus and continuous feeding modes influence splanchnic oxygenation in healthy preterm infants differently. Further studies are needed to investigate possible underlying mechanisms and potential effects on feeding tolerance.
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Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth 2014; 24:74-88. [PMID: 24267637 DOI: 10.1111/pan.12301] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
The safety of anesthesia has improved greatly in the past three decades. Standard perioperative monitoring, including pulse oximetry, has practically eliminated unrecognized arterial hypoxia as a cause for perioperative injury. However, most anesthesia-related cardiac arrests in children are now cardiovascular in origin, and standard monitoring is unable to detect many circulatory abnormalities. Near-infrared spectroscopy provides noninvasive continuous access to the venous side of regional circulations that can approximate organ-specific and global measures to facilitate the detection of circulatory abnormalities and drive goal-directed interventions to reduce end-organ ischemic injury.
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Affiliation(s)
- John P Scott
- Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Pediatric Anesthesiology and Critical Care Medicine, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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