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Spicer AB, Cavalcanti AB, Zampieri FG. Subgroup analyses and heterogeneity of treatment effects in randomized trials: a primer for the clinician. Curr Opin Crit Care 2024; 30:427-438. [PMID: 39150040 DOI: 10.1097/mcc.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW To date, most randomized clinical trials in critical care report neutral overall results. However, research as to whether heterogenous responses underlie these results and give opportunity for personalized care is gaining momentum but has yet to inform clinical practice guidance. Thus, we aim to provide an overview of methodological approaches to estimating heterogeneity of treatment effects in randomized trials and conjecture about future paths to application in patient care. RECENT FINDINGS Despite their limitations, traditional subgroup analyses are still the most reported approach. More recent methods based on subphenotyping, risk modeling and effect modeling are still uncommonly embedded in primary reports of clinical trials but have provided useful insights in secondary analyses. However, further simulation studies and subsequent guidelines are needed to ascertain the most efficient and robust manner to validate these results for eventual use in practice. SUMMARY There is an increasing interest in approaches that can identify heterogeneity in treatment effects from randomized clinical trials, extending beyond traditional subgroup analyses. While prospective validation in further studies is still needed, these approaches are promising tools for design, interpretation, and implementation of clinical trial results.
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Affiliation(s)
- Alexandra B Spicer
- Department of Medicine: Allergy, Pulmonary and Critical Care Division; UW School of Medicine and Public Health
| | | | - Fernando G Zampieri
- HCor Research Institute, Sao Paulo, Brazil
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
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Solís-García G, Bravo MC, Pellicer A. Cardiorespiratory interactions during the transitional period in extremely preterm infants: a narrative review. Pediatr Res 2024:10.1038/s41390-024-03451-6. [PMID: 39179873 DOI: 10.1038/s41390-024-03451-6] [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: 05/16/2024] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 08/26/2024]
Abstract
We aimed to review the physiology and evidence behind cardiorespiratory interactions during the transitional circulation of extremely preterm infants with fragile physiology and to propose a framework for future research. Cord clamping strategies have a great impact on initial haemodynamic changes, and appropriate transition can be facilitated by establishing spontaneous ventilation before cord clamping. Mechanical ventilation modifies preterm transitional haemodynamics, with positive pressure ventilation affecting the right and left heart loading conditions. Pulmonary vascular resistances can be minimized by ventilating with optimal lung volumes at functional residual capacity, and other pulmonary vasodilator treatments such as inhaled nitric oxide can be used to improve ventilation/perfusion mismatch. Different cardiovascular drugs can be used to provide support during transition in this population, and it is important to understand both their cardiovascular and respiratory effects, in order to provide adequate support to vulnerable preterm infants and improve outcomes. Current available non-invasive bedside tools, such as near-infrared spectroscopy, targeted neonatal echocardiography, or lung ultrasound offer the opportunity to precisely monitor cardiorespiratory interactions in preterm infants. More research is needed in this field using precision medicine to strengthen the benefits and avoid the harms associated to early neonatal interventions. IMPACT: In extremely preterm infants, haemodynamic and respiratory transitions are deeply interconnected, and their changes have a key impact in the establishment of lung aireation and postnatal circulation. We describe how mechanical ventilation modifies heart loading conditions and pulmonary vascular resistances in preterm patients, and how hemodynamic interventions such as cord clamping strategies or cardiovascular drugs affect the infant respiratory status. Current available non-invasive bedside tools can help monitor cardiorespiratory interactions in preterm infants. We highlight the areas of research in which precision medicine can help strengthen the benefits and avoid the harms associated to early neonatal interventions.
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Affiliation(s)
- Gonzalo Solís-García
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain.
| | - María Carmen Bravo
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
- Consultant Neonatologist, Rotunda Hospital, Dublin, Ireland
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital and IdiPaz (La Paz Hospital Institute for Health Research), Madrid, Spain
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Ćaleta T, Ryll MJ, Bojanić K, Dessardo NS, Schroeder DR, Sprung J, Weingarten TN, Radoš M, Kostović I, Grizelj R. Regional cerebral oxygen saturation variability and brain injury in preterm infants. Front Pediatr 2024; 12:1426874. [PMID: 39105161 PMCID: PMC11298368 DOI: 10.3389/fped.2024.1426874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024] Open
Abstract
Objective To examine whether variation of regional cerebral oxygen saturation (rScO2) within three days after delivery predicts development of brain injury (intraventricular/cerebellar hemorrhage or white matter injury) in preterm infants. Study design A prospective study of neonates <32 weeks gestational age with normal cranial ultrasound admitted between 2018 and 2022. All received rScO2 monitoring with near-infrared spectroscopy at admission up to 72 h of life. To assess brain injury a magnetic resonance imaging was performed at term-equivalent age. We assessed the association between rScO2 variability (short-term average real variability, rScO2ARV, and standard deviation, rScO2SD), mean rScO2 (rScO2MEAN), and percentage of time rScO2 spent below 60% (rScO2TIME<60%) during the first 72 h of life and brain injury. Results The median [IQR] time from birth to brain imaging was 68 [59-79] days. Of 81 neonates, 49 had some form of brain injury. Compared to neonates without injury, in those with injury rScO2ARV was higher during the first 24 h (P = 0.026); rScO2SD was higher at 24 and 72 h (P = 0.029 and P = 0.030, respectively), rScO2MEAN was lower at 48 h (P = 0.042), and rScO2TIME<60% was longer at 24, 48, and 72 h (P = 0.050, P = 0.041, and P = 0.009, respectively). Similar results were observed in multivariable logistic regression. Although not all results were statistically significant, increased rScO2 variability (rScO2ARV and rScO2SD) and lower mean values of rScO2 were associated with increased likelihood of brain injury. Conclusions In preterm infants increased aberration of rScO2 in early postdelivery period was associated with an increased likelihood of brain injury diagnosis at term-equivalent age.
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Affiliation(s)
- Tomislav Ćaleta
- Department of Pediatrics, School of Medicine University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Martin J. Ryll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Katarina Bojanić
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Nada Sindičić Dessardo
- Department of Pediatrics, School of Medicine University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darrell R. Schroeder
- Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Toby N. Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Milan Radoš
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Ivica Kostović
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Ruža Grizelj
- Department of Pediatrics, School of Medicine University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
- Center for Research on Perinatal Etiopathogenesis of Neurological and Cognitive Diseases, School of Medicine University of Zagreb, Zagreb, Croatia
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Chock VY, Vesoulis ZA, El-Dib M, Austin T, van Bel F. The Future of Neonatal Cerebral Oxygenation Monitoring: Directions After the SafeBoosC-III Trial. J Pediatr 2024; 270:114016. [PMID: 38492916 DOI: 10.1016/j.jpeds.2024.114016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA.
| | | | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Alsina-Casanova M, Lühr-Hansen M, Aldecoa-Bilbao V, Del Rio R, Maton P, Sarafidis K, Zafra-Rodriguez P, Vesoulis ZA, Mastretta E, Bresesti I, Gomez-Chiari M, Rebollo M, Khamis J, Baltatzidis A, Benavente-Fernandez I, Shimony J, Morana G, Agosti M, Carreras N, Cuaresma A, Gau A, Anastasiou A, Lubian-López SP, Alexopoulos D, Sciortino P, Dessimone F, Harboe Olsen M, Agut T, Greisen G. Effect of Cerebral Oximetry-Guided Treatment on Brain Injury in Preterm Infants as Assessed by Magnetic Resonance Imaging at Term Equivalent Age: An Ancillary SafeBoosC-III Study. Neonatology 2024:1-8. [PMID: 38934161 DOI: 10.1159/000539175] [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: 03/14/2024] [Accepted: 04/27/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA). METHODS MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors. RESULTS A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91-0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1-4) and the usual care group (median 3, IQR: 1-4; median difference -1 to 0, 95% HLCI: -1 to 0; p value 0.1196). CONCLUSIONS In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials.
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Affiliation(s)
- Miguel Alsina-Casanova
- Department of Neonatology, Hospital Clínic Barcelona, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Barcelona, Spain
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Mathias Lühr-Hansen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Victoria Aldecoa-Bilbao
- Department of Neonatology, Hospital Clínic Barcelona, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Barcelona, Spain
| | - Ruth Del Rio
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Pierre Maton
- Service de Néonatologie, Clinique CHC Montlégia, Liege, Belgium
| | - Kosmas Sarafidis
- 1st Department of Neonatology, Aristotle University of Thessaloniki, Ippokrateion General Hospital of Thessaloniki, Thesaloniki, Greece
| | | | - Zachary Andrew Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Emmanuele Mastretta
- SC Neonatologia, Osp. S.Anna-Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilia Bresesti
- Department of Neonatology, Neonatal Intensive Care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Marta Gomez-Chiari
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mónica Rebollo
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Radiology, Pediatric Radiology Section University of Geneva, Geneva, Switzerland
| | - Jamil Khamis
- Service d'Imagerie médicale, Clinique CHC Montlégia, Liege, Belgium
| | - Angelos Baltatzidis
- Department of Radiology, Ippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Joshua Shimony
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Giovanni Morana
- Dipartimento di Neuroscienze, Università di Torino, Turin, Italy
| | - Massimo Agosti
- Department of Neonatology, Neonatal Intensive Care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Nuria Carreras
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Adriana Cuaresma
- Department of Neonatology, Hospital Clínic Barcelona, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Barcelona, Spain
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Ambre Gau
- Service d'Imagerie médicale, Clinique CHC Montlégia, Liege, Belgium
| | - Athanasia Anastasiou
- Department of Radiology, Ippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios Alexopoulos
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paola Sciortino
- SC Neuroradiologia, Città della Scienza e della Salute Torino, Turin, Italy
| | - Francesca Dessimone
- Department of Neonatology, Neonatal Intensive Care Unit and Pediatrics, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thais Agut
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Schettler KF. Neuromonitoring in neonatal intensive care units-an important need towards individualized neuroprotective care. Eur J Pediatr 2024:10.1007/s00431-024-05642-z. [PMID: 38858228 DOI: 10.1007/s00431-024-05642-z] [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: 05/05/2024] [Revised: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
Neuromonitoring has been widely accepted as an important part in neonatal care. Amplitude-integrated EEG (aEEG) and near-infrared spectroscopy (NIRS) are often mentioned in this context, though being only a part of the fully array of methods and examinations that could be considered neuromonitoring. Within the broad array of medical conditions that could be encountered in a neonatal patient, it is important to be aware of the indications for neuromonitoring and especially which neuromonitoring technique to use best for the individual condition. aEEG is now a widely accepted neuromonitor in neonatology with its value in hypoxic events and seizures only rarely questioned. Other methods like NIRS still have to prove themselves in the future. The SafeBoosC-III trial showed that it still remains difficult for some of these methods to prove their value for the improvement of outcome. Bute future developments such as multimodal neuromonitoring with data integration and artificial intelligence analysis could improve the value of these methods.
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Chang YT, Liu JR, Chen WM, Tseng CN, See LC. First-year outcomes of very low birth weight preterm singleton infants with hypoxemic respiratory failure treated with milrinone and inhaled nitric oxide (iNO) compared to iNO alone: A nationwide retrospective study. PLoS One 2024; 19:e0297137. [PMID: 38722851 PMCID: PMC11081351 DOI: 10.1371/journal.pone.0297137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/28/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Inhaled nitric oxide (iNO) has a beneficial effect on hypoxemic respiratory failure. The increased use of concurrent iNO and milrinone was observed. We aimed to report the trends of iNO use in the past 15 years in Taiwan and compare the first-year outcomes of combining iNO and milrinone to the iNO alone in very low birth weight preterm (VLBWP) infants under mechanical ventilation. METHODS This nationwide cohort study enrolled preterm singleton infants with birth weight <1500g treated with iNO from 2004 to 2019. Infants were divided into two groups, with a combination of intravenous milrinone (Group 2, n = 166) and without milrinone (Group 1, n = 591). After propensity score matching (PSM), each group's sample size is 124. The primary outcomes were all-cause mortality and the respiratory condition, including ventilator use and duration. The secondary outcomes were preterm morbidities within one year after birth. RESULTS After PSM, more infants in Group 2 needed inotropes. The mortality rate was significantly higher in Group 2 than in Group 1 from one month after birth till 1 year of age (55.1% vs. 13.5%) with the adjusted hazard ratio of 4.25 (95%CI = 2.42-7.47, p <0.001). For infants who died before 36 weeks of postmenstrual age (PMA), Group 2 had longer hospital stays compared to Group 1. For infants who survived after 36 weeks PMA, the incidence of moderate and severe bronchopulmonary dysplasia (BPD) was significantly higher in Group 2 than in Group 1. For infants who survived until one year of age, the incidence of pneumonia was significantly higher in Group 2 (28.30%) compared to Group 1 (12.62%) (p = 0.0153). CONCLUSION Combined treatment of iNO and milrinone is increasingly applied in VLBWP infants in Taiwan. This retrospective study did not support the benefits of combining iNO and milrinone on one-year survival and BPD prevention. A future prospective study is warranted.
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Affiliation(s)
- Ya-Ting Chang
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wei-Min Chen
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chi-Nan Tseng
- Department of Cardiac Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan City, Taiwan
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Agakidou E, Chatziioannidis I, Kontou A, Stathopoulou T, Chotas W, Sarafidis K. An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication. CHILDREN (BASEL, SWITZERLAND) 2024; 11:490. [PMID: 38671707 PMCID: PMC11049273 DOI: 10.3390/children11040490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.
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Affiliation(s)
- Eleni Agakidou
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - Ilias Chatziioannidis
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - Angeliki Kontou
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - Theodora Stathopoulou
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
| | - William Chotas
- Department of Neonatology, University of Vermont, Burlington, VT 05405, USA
| | - Kosmas Sarafidis
- 1st Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Ippokrateion General Hospital, 54642 Thessaloniki, Greece; (I.C.); (A.K.); (T.S.); (K.S.)
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Dusleag M, Urlesberger B, Schwaberger B, Baik-Schneditz N, Schlatzer C, Wolfsberger CH, Pichler G. Acid base and metabolic parameters of the umbilical cord blood and cerebral oxygenation immediately after birth. Front Pediatr 2024; 12:1385726. [PMID: 38606368 PMCID: PMC11007157 DOI: 10.3389/fped.2024.1385726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Objective Aim was to investigate whether acid-base and metabolic parameters obtained from arterial umbilical cord blood affect cerebral oxygenation after birth in preterm neonates with respiratory support and in term neonates without respiratory support. Study design This was a post-hoc analysis of secondary outcome parameters of a prospective observational study including preterm neonates with and term neonates without respiratory support. Non-asphyxiated neonates with cerebral oxygenation measured with near-infrared spectroscopy during the first 15 min and with blood gas analyses from arterial umbilical cord blood were included. Arterial oxygen saturation (SpO2) and heart rate (HR) were monitored with pulse oximetry. Potential correlations were investigated between acid-base and metabolic parameters (pH-value, bicarbonate, base-excess, and lactate) and crSO2/cFTOE 5 min after birth. Results Seventy-seven neonates were included: 14 preterm neonates with respiratory support (mean gestational age [GA] 31.4 ± 4.1 weeks; mean birth weight [BW] 1,690 ± 640 g) and 63 term neonates without respiratory support (GA 38.7 ± 0.8 weeks; BW 3,258 ± 443 g). Mean crSO2 5 min after birth was 44.0% ± 24.2% in preterm and 62.2% ± 20.01% in term neonates. Mean cFTOE 5 min after birth was 0.46 ± 0.06 in preterm and 0.27 ± 0.19 in term neonates. In preterm neonates with respiratory support higher lactate was significantly associated with lower crSO2 and SpO2 and tended to be associated with higher cFTOE. In term neonates without respiratory support no significant correlations were found. Conclusion In non-asphyxiated preterm neonates with respiratory support, lactate levels were negatively associated with crSO2 and SpO2, whereas in term neonates without respiratory support no associations were observed.
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Affiliation(s)
- Martin Dusleag
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nariae Baik-Schneditz
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Schlatzer
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christina H Wolfsberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Leadley G, Austin T, Bale G. Review of measurements and imaging of cytochrome-c-oxidase in humans using near-infrared spectroscopy: an update. BIOMEDICAL OPTICS EXPRESS 2024; 15:162-184. [PMID: 38223181 PMCID: PMC10783912 DOI: 10.1364/boe.501915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Abstract
This review examines advancements in the measurement and imaging of oxidized cytochrome-c-oxidase (oxCCO) using near-infrared spectroscopy (NIRS) in humans since 2016. A total of 34 published papers were identified, with a focus on both adult and neonate populations. The NIRS-derived oxCCO signal has been demonstrated to correlate with physiological parameters and hemodynamics. New instrumentation, such as systems that allow the imaging of changes of oxCCO with diffuse optical tomography or combine the oxCCO measurement with diffuse correlation spectroscopy measures of blood flow, have advanced the field in the past decade. However, variability in its response across different populations and paradigms and lack of standardization limit its potential as a reliable and valuable indicator of brain health. Future studies should address these issues to fulfill the vision of oxCCO as a clinical biomarker.
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Affiliation(s)
- Georgina Leadley
- Department of Paediatrics, University of Cambridge, UK
- Department of Engineering, University of Cambridge, UK
- Department of Medical Physics and Biomedical Engineering, UCL, UK
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, UK
| | - Gemma Bale
- Department of Engineering, University of Cambridge, UK
- Department of Physics, University of Cambridge, UK
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11
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Kim F, Bateman DA, Garey D, Goldshtrom N, Isler JR, Sahni R, Wallman-Stokes A. Association between intermittent hypoxemia and neurodevelopmental outcomes in extremely premature infants: A single-center experience. Early Hum Dev 2024; 188:105919. [PMID: 38118389 DOI: 10.1016/j.earlhumdev.2023.105919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/03/2023] [Accepted: 12/07/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE To describe the association between intermittent hypoxemic events (IHEs) and severe neurodevelopmental impairment (SNDI) or death in extremely premature infants. STUDY DESIGN Retrospective study of extremely premature infants 230/7-276/7 weeks gestational age (GA) and birthweight (BW) ≤1250 grams (g) admitted to a level IV neonatal intensive care unit (NICU) from 2013 to 2017. IHEs, defined as events with SpO2 ≤ 80 % lasting 10 s to 5 min, were algorithmically identified using data extracted from bedside monitors at 2 s intervals (0.5 Hz). The primary outcome was SNDI at 18-24 months corrected age (CA), defined as a Bayley-III motor, language or cognitive composite score ≤69, or death before discharge while the secondary outcome was SNDI alone. We used mixed-effects regression models to evaluate the relationship between mean daily IHE rate per postnatal week of life for the first 12 weeks and the outcomes, and logistic regression models to assess the association between outcomes and summary measures of hypoxic burden for the entire NICU hospitalization. RESULTS The mortality rate was 7 % (18/249) during NICU hospitalization. Of 249 infants born during this time period, IHE and neurodevelopmental outcome data were fully available for 65 infants (mean GA 26 ± 1.4 weeks, mean birth weight (BW) 738 ± 199 g. The outcome of SNDI alone occurred in 34 % (22/65) with a majority demonstrating motor or language delay on the Bayley-III. Although mean daily IHE rate/week was not associated with SNDI or death, total IHE duration was associated with increased odds of SNDI (OR (95 % CI) 1.03 (1.01, 1.05), p = 0.008) in models adjusted for GA. CONCLUSIONS In a cohort of extremely premature infants 23-27 weeks GA, each hour of total IHE duration (SpO2 ≤ 80 %) was associated with a 2.7 % (0.7 %, 4.8 %) increase in the odds of SNDI at 18-24 months CA.
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Affiliation(s)
- Faith Kim
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America.
| | - David A Bateman
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Donna Garey
- Department of Pediatrics, Phoenix Children's Medical Group, Phoenix, AZ, United States of America
| | - Nimrod Goldshtrom
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Joseph R Isler
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Rakesh Sahni
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Aaron Wallman-Stokes
- Department of Pediatrics, University of Vermont Children's Hospital, Burlington, VT, United States of America
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12
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Taha S, Simpson RB, Sharkey D. The critical role of technologies in neonatal care. Early Hum Dev 2023; 187:105898. [PMID: 37944264 DOI: 10.1016/j.earlhumdev.2023.105898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Neonatal care has made significant advances in the last few decades. As a result, mortality and morbidity in high-risk infants, such as extremely preterm infants or those infants with birth-related brain injury, has reduced significantly. Many of these advances have been facilitated or delivered through development of medical technologies allowing clinical teams to be better supported with the care they deliver or provide new therapies and diagnostics to improve management. The delivery of neonatal intensive care requires the provision of medical technologies that are easy to use, reliable, accurate and ideally developed for the unique needs of the newborn population. Many technologies have been developed and commercialised following adult trials without ever being studied in neonatal patients despite the unique characteristics of this population. Increasingly, funders and industry are recognising this major challenge which has resulted in initiatives to develop new ideas from concept through to clinical care. This review explores some of the key medical technologies used in neonatal care and the evidence to support their adoption to improve outcomes. A number of devices have yet to realise their full potential and will require further development to optimise and find their ideal target population and clinical benefit. Examples of emerging technologies, which may soon become more widely used, are also discussed. As neonatal care relies more on medical technologies, we need to be aware of the impact on care pathways, especially from a human factors approach, the associated costs and subsequent benefits to patients alongside the supporting evidence.
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Affiliation(s)
- Syed Taha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Rosalind B Simpson
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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13
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Olsen MH, Hansen ML, Lange T, Gluud C, Thabane L, Greisen G, Jakobsen JC. Detailed statistical analysis plan for a secondary Bayesian analysis of the SafeBoosC-III trial: a multinational, randomised clinical trial assessing treatment guided by cerebral oximetry monitoring versus usual care in extremely preterm infants. Trials 2023; 24:737. [PMID: 37974280 PMCID: PMC10655478 DOI: 10.1186/s13063-023-07720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Extremely preterm infants have a high mortality and morbidity. Here, we present a statistical analysis plan for secondary Bayesian analyses of the pragmatic, sufficiently powered multinational, trial-SafeBoosC III-evaluating the benefits and harms of cerebral oximetry monitoring plus a treatment guideline versus usual care for such infants. METHODS The SafeBoosC-III trial is an investigator-initiated, open-label, randomised, multinational, pragmatic, phase III clinical trial with a parallel-group design. The trial randomised 1601 infants, and the frequentist analyses were published in April 2023. The primary outcome is a dichotomous composite outcome of death or severe brain injury. The exploratory outcomes are major neonatal morbidities associated with neurodevelopmental impairment later in life: (1) bronchopulmonary dysplasia; (2) retinopathy of prematurity; (3) late-onset sepsis; (4) necrotising enterocolitis; and (5) number of major neonatal morbidities (count of bronchopulmonary dysplasia, retinopathy of prematurity, and severe brain injury). The primary Bayesian analyses will use non-informed priors including all plausible effects. The models will use a Hamiltonian Monte Carlo sampler with 1 chain, a sampling of 10,000, and at least 25,000 iterations for the burn-in period. In Bayesian statistics, such analyses are referred to as 'posteriors' and will be presented as point estimates with 95% credibility intervals (CrIs), encompassing the most probable results based on the data, model, and priors selected. The results will be presented as probability of any benefit or any harm, Bayes factor, and the probability of clinical important benefit or harm. Two statisticians will analyse the blinded data independently following this protocol. DISCUSSION This statistical analysis plan presents a secondary Bayesian analysis of the SafeBoosC-III trial. The analysis and the final manuscript will be carried out and written after we publicise the primary frequentist trial report. Thus, we can interpret the findings from both the frequentists and Bayesian perspective. This approach should provide a better foundation for interpreting of our findings. TRIAL REGISTRATION ClinicalTrials.org, NCT03770741. Registered on 10 December 2018.
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Affiliation(s)
- Markus Harboe Olsen
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark.
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark.
| | - Mathias Lühr Hansen
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Neonatology, Juliane Marie Centre, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Publich Health, Copenhagen University, Øster Farimagsgade 5, Copenhagen K, Denmark
| | - Christian Gluud
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- The Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Gorm Greisen
- Department of Neonatology, Juliane Marie Centre, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- The Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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14
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Noroozi-Clever MB, Liao SM, Whitehead HV, Vesoulis ZA. Preterm Infants off Positive Pressure Respiratory Support Have a Higher Incidence of Occult Cerebral Hypoxia. J Pediatr 2023; 262:113648. [PMID: 37517651 PMCID: PMC10822026 DOI: 10.1016/j.jpeds.2023.113648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To use cerebral near-infrared spectroscopy (NIRS) to quantify occult cerebral hypoxia across respiratory support modes in preterm infants. STUDY DESIGN In this prospective, longitudinal, observational study, infants ≤32 weeks gestation underwent serial pulse oximetry (oxygen saturation [SpO2]) and cerebral NIRS monitoring (4-6 hours per session) following a standardized recording schedule (daily for 2 weeks, every other day for 2 weeks, then weekly until 35 weeks corrected gestational age). Four calculations were made: median cerebral saturation, median cerebral hypoxia burden (proportion of NIRS samples below the hypoxia threshold [<67%]), median systemic saturation, and median systemic hypoxia burden (proportion of SpO2 samples below the desaturation threshold [<85%]). During each recording session, respiratory support mode was noted (room air, low-flow nasal cannula, high-flow nasal cannula, noninvasive positive pressure ventilation, continuous positive airway pressure, and invasive ventilation). RESULTS There were 1013 recording sessions made from 174 infants with a median length of 6.9 hours. Although the systemic (SpO2) hypoxia burden was significantly greater for infants on the highest respiratory support (invasive and noninvasive positive pressure ventilation), the cerebral hypoxia burden was significantly greater during recording sessions made on the lowest respiratory support (8% for room air; 29% for low-flow nasal cannula). CONCLUSIONS Premature infants on the highest levels of respiratory support have less cerebral hypoxia than those on lower respiratory support. These results raise concern about unrecognized cerebral hypoxia during lower acuity periods of neonatal intensive care unit hospitalization and adverse outcomes.
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Affiliation(s)
- Mona B Noroozi-Clever
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Steve M Liao
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Halana V Whitehead
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
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15
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Mu Y, Wang H, Tian M, Hu Y, Feng Y, Lu R, He Q, Jiang S, Huang J, Duan S, Mu D. Cross-sectional association between red blood cell distribution width and regional cerebral tissue oxygen saturation in preterm infants in the first 14 days after birth. Front Pediatr 2023; 11:1238762. [PMID: 38027304 PMCID: PMC10644271 DOI: 10.3389/fped.2023.1238762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hypoxia can threaten the metabolic functions of different systems in immature neonates, particularly the central nervous system. The red blood cell distribution width (RDW) has recently been reported as a prognostic factor in neurologic diseases. Herein, we examined the correlation between RDW and regional cerebral tissue oxygen saturation (rcSO2). Methods This cross-sectional study included 110 preterm infants born at a gestational age (GA) of <32 weeks, or with a birth weight (BW) of <1,500 g at our institution between January and June 2,022. The rcSO2 was monitored using near-infrared spectroscopy, and RDW was extracted from the complete blood count during the first 14 days after birth. RDW and rcSO2 measurements were analyzed using a cross-sectional research method. Results We divided the study population into two groups, with a mean rcSO2 value over the first 14 days. Fifty-three preterm had rcSO2 ≥ 55% and 57% < 55%. The 14-days-mean in the study population showing an association of lower rcSO2 values with higher RDW values. Significantly higher RDW values were observed in the low rcSO2 group compared with those in the high rcSO2 group. Threshold effect analysis showed that rcSO2 decreased with RDW values ≥18% (β, -0.03; 95% CI, -0.04 and -0.02; p ≥ 0.0001). After adjusting for potential confounders, an RDW of ≥18% was determined as the predictive cutoff value for preterm infants with low rcSO2 (Model I: OR, 3.31; 95% CI, 1.36-8.06; p = 0.009; and Model II: OR, 3.31; 95% CI, 1.28-8.53; p = 0.013). Conclusions An RDW of ≥18% in the first 14 days is associated with rcSO2 of <55% in preterm infants.
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Affiliation(s)
- Yuju Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Mengting Tian
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yong Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yi Feng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Ruifeng Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Qi He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Shouliang Jiang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jinglan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Surong Duan
- Department of Clinical Medicine, BinZhou Medical College, Yantai, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Disease ofWomen and Children, Ministry of Education, Sichuan University, Chengdu, China
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16
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Vestager ML, Hansen ML, Rasmussen MI, Hahn GH, Hyttel-Sørensen S, Pellicer A, Heuchan AM, Hagmann C, Dempsey E, Dimitriou G, Pichler G, Naulaers G, Fuchs H, Tkaczyk J, Mintzer J, Fumagalli M, Nesargi S, Fredly S, Szczapa T, Gluud C, Jakobsen JC, Greisen G. The effects of cerebral oximetry in mechanically ventilated newborns: a protocol for the SafeBoosC-IIIv randomised clinical trial. Trials 2023; 24:696. [PMID: 37898759 PMCID: PMC10612349 DOI: 10.1186/s13063-023-07699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/04/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The SafeBoosC project aims to test the clinical value of non-invasive cerebral oximetry by near-infrared spectroscopy in newborn infants. The purpose is to establish whether cerebral oximetry can be used to save newborn infants' lives and brains or not. Newborns contribute heavily to total childhood mortality and neonatal brain damage is the cause of a large part of handicaps such as cerebral palsy. The objective of the SafeBoosC-IIIv trial is to evaluate the benefits and harms of cerebral oximetry added to usual care versus usual care in mechanically ventilated newborns. METHODS/DESIGN SafeBoosC-IIIv is an investigator-initiated, multinational, randomised, pragmatic phase-III clinical trial. The inclusion criteria will be newborns with a gestational age more than 28 + 0 weeks, postnatal age less than 28 days, predicted to require mechanical ventilation for at least 24 h, and prior informed consent from the parents or deferred consent or absence of opt-out. The exclusion criteria will be no available cerebral oximeter, suspicion of or confirmed brain injury or disorder, or congenital heart disease likely to require surgery. A total of 3000 participants will be randomised in 60 neonatal intensive care units from 16 countries, in a 1:1 allocation ratio to cerebral oximetry versus usual care. Participants in the cerebral oximetry group will undergo cerebral oximetry monitoring during mechanical ventilation in the neonatal intensive care unit for as long as deemed useful by the treating physician or until 28 days of life. The participants in the cerebral oximetry group will be treated according to the SafeBoosC treatment guideline. Participants in the usual care group will not receive cerebral oximetry and will receive usual care. We use two co-primary outcomes: (1) a composite of death from any cause or moderate to severe neurodevelopmental disability at 2 years of corrected age and (2) the non-verbal cognitive score of the Parent Report of Children's Abilities-Revised (PARCA-R) at 2 years of corrected age. DISCUSSION There is need for a randomised clinical trial to evaluate cerebral oximetry added to usual care versus usual care in mechanically ventilated newborns. TRIAL REGISTRATION The protocol is registered at www. CLINICALTRIALS gov (NCT05907317; registered 18 June 2023).
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Affiliation(s)
- Maria Linander Vestager
- Department of Neonatology, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark.
| | - Mathias Lühr Hansen
- Department of Neonatology, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | - Marie Isabel Rasmussen
- Department of Neonatology, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | - Gitte Holst Hahn
- Department of Neonatology, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | - Simon Hyttel-Sørensen
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Cornelia Hagmann
- Department of Neonatology, Children's University Hospital of Zürich, Zurich, Switzerland
| | - Eugene Dempsey
- Infant Centre and Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Gabriel Dimitriou
- NICU, Department of Paediatrics, University General Hospital of Patras, Patras, Greece
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Leuven, Louvain, Belgium
| | - Hans Fuchs
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescents Medicine, Medical Center ─ University of Freiburg, Freiburg, Germany
| | - Jakub Tkaczyk
- Department of Neonatology, University Hospital Motol, Prague, Czech Republic
| | - Jonathan Mintzer
- The Department of Pediatrics, Division of Newborn Medicine, Mountainside Medical Center, Montclair, NJ, USA
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Siv Fredly
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
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17
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Rasmussen MI, Hansen ML, Pellicer A, Gluud C, Dempsey E, Mintzer J, Hyttel-Sørensen S, Heuchan AM, Hagmann C, Ergenekon E, Dimitriou G, Pichler G, Naulaers G, Cheng G, Tkaczyk J, Fuchs H, Fumagalli M, Nesargi S, Fredly S, Szczapa T, Plomgaard AM, Hansen BM, Jakobsen JC, Greisen G. Cerebral oximetry monitoring versus usual care for extremely preterm infants: a study protocol for the 2-year follow-up of the SafeBoosC-III randomised clinical trial. Trials 2023; 24:653. [PMID: 37805539 PMCID: PMC10560418 DOI: 10.1186/s13063-023-07653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/14/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND In the SafeBoosC-III trial, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth did not reduce the incidence of death or severe brain injury in extremely preterm infants at 36 weeks' postmenstrual age, as compared with usual care. Despite an association between severe brain injury diagnosed in the neonatal period and later neurodevelopmental disability, this relationship is not always strong. The objective of the SafeBoosC-III follow-up study is to assess mortality, neurodevelopmental disability, or any harm in trial participants at 2 years of corrected age. One important challenge is the lack of funding for local costs for a trial-specific assessment. METHODS Of the 1601 infants randomised in the SafeBoosC-III trial, 1276 infants were alive at 36 weeks' postmenstrual age and will potentially be available for the 2-year follow-up. Inclusion criteria will be enrollment in a neonatal intensive care unit taking part in the follow-up study and parental consent if required by local regulations. We aim to collect data from routine follow-up programmes between the ages of 18 and 30 months of corrected age. If no routine follow-up has been conducted, we will collect informal assessments from other health care records from the age of at least 12 months. A local co-investigator blinded to group allocation will classify outcomes based on these records. We will supplement this with parental questionnaires including the Parent Report of Children's Abilities-Revised. There will be two co-primary outcomes: the composite of death or moderate or severe neurodevelopmental disability and mean Bayley-III/IV cognitive score. We will use a 3-tier model for prioritisation, based on the quality of data. This approach has been chosen to minimise loss to follow-up assuming that little data is better than no data at all. DISCUSSION Follow-up at the age of 2 years is important for intervention trials in the newborn period as only time can show real benefits and harms later in childhood. To decrease the risk of generalisation and data-driven biased conclusions, we present a detailed description of the methodology for the SafeBoosC-III follow-up study. As funding is limited, a pragmatic approach is necessary. TRIAL REGISTRATION ClinicalTrials.gov NCT05134116 . Registered on 24 November 2021.
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Affiliation(s)
- Marie Isabel Rasmussen
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Denmark
| | - Mathias Lühr Hansen
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Denmark
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Christian Gluud
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Eugene Dempsey
- Infant Research Centre and Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Jonathan Mintzer
- Department of Pediatrics, Division of Newborn Medicine, Mountainside Medical Center, Montclair, NJ USA
| | - Simon Hyttel-Sørensen
- Department of Intensive Care, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | | | - Cornelia Hagmann
- Department of Neonatology, Children’s University Hospital of Zürich, Zurich, Switzerland
| | - Ebru Ergenekon
- Department of Neonatology, Gazi University Hospital, Yenimahalle, Ankara, Turkey
| | - Gabriel Dimitriou
- Department of Pediatrics, NICU, University General Hospital of Patras, Patras, Greece
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Leuven, Louvain, Belgium
| | - Guoqiang Cheng
- Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Jakub Tkaczyk
- Department of Neonatology, University Hospital Motol, Prague, Czech Republic
| | - Hans Fuchs
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescents Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Monica Fumagalli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Siv Fredly
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Tomasz Szczapa
- II Department of Neonatology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Bo Mølholm Hansen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Hilleroed, Denmark
| | - Janus Christian Jakobsen
- Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Denmark
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Chock VY, Kirpalani H, Bell EF, Tan S, Hintz SR, Ball MB, Smith E, Das A, Loggins YC, Sood BG, Chalak LF, Wyckoff MH, Kicklighter SD, Kennedy KA, Patel RM, Carlo WA, Johnson KJ, Watterberg KL, Sánchez PJ, Laptook AR, Seabrook RB, Cotten CM, Mancini T, Sokol GM, Ohls RK, Hibbs AM, Poindexter BB, Reynolds AM, DeMauro SB, Chawla S, Baserga M, Walsh MC, Higgins RD, Van Meurs KP. Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants: A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS). JAMA Netw Open 2023; 6:e2334889. [PMID: 37733345 PMCID: PMC10514737 DOI: 10.1001/jamanetworkopen.2023.34889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/18/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes. Objective To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age. Design, Setting, and Participants This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022. Interventions Near-infrared spectroscopy monitoring of Csat and Msat. Main Outcomes and Measures Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score <85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment. Results A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower-hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher-hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO2) in either group (0.2% vs -0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03). Conclusions and Relevance In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO2. Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia. Trial Registration ClinicalTrials.gov Identifier: NCT01702805.
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Affiliation(s)
- Valerie Y. Chock
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Haresh Kirpalani
- Department of Pediatrics, University of Pennsylvania, Philadelphia
| | | | - Sylvia Tan
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - M. Bethany Ball
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Emily Smith
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Yvonne C. Loggins
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Beena G. Sood
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Lina F. Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Stephen D. Kicklighter
- Division of Neonatology, Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Kathleen A. Kennedy
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston
| | - Ravi M. Patel
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham
| | | | | | - Pablo J. Sánchez
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
| | - Ruth B. Seabrook
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | | | - Toni Mancini
- Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Robin K. Ohls
- University of New Mexico Health Sciences Center, Albuquerque
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Anna Maria Hibbs
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Brenda B. Poindexter
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anne Marie Reynolds
- Department of Pediatrics, University of Buffalo Women’s and Children’s Hospital of Buffalo, Buffalo, New York
| | - Sara B. DeMauro
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sanjay Chawla
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Mariana Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Michele C. Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Research and Sponsored Programs, Florida Gulf Coast University, Fort Myers
| | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
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Wirayannawat W, Amawat J, Yamsiri N, Paes B, Kitsommart R. Comparison of the SenSmart™ and the INVOS™ neonatal cerebral near-infrared spectrometry devices. Front Pediatr 2023; 11:1243977. [PMID: 37691777 PMCID: PMC10485771 DOI: 10.3389/fped.2023.1243977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives To determine the correlation and agreement between the SenSmart™ and the INVOS™ devices of neonatal cerebral regional oxygen saturation (CrSO2) measurements using neonatal sensors. The secondary objective was to develop a regression model that predicts CrSO2-INVOS values using CrSO2-SenSmart indices and determine whether the values between the devices are interchangeable. Methods A prospective, cross-sectional study was conducted in infants during the first 4 weeks of life. Simultaneous, bilateral CrSO2 was measured using the SenSmart™X100 (CrSO2-SenSmart) or INVOS™ 5100C (CrSO2-INVOS) device in each frontoparietal area for 2 h. Five-minute CrSO2 values were extracted for analysis. Results Thirty infants were recruited with 720 pairwise measurements and 26 (84%) were evaluated in the first week of life. Mean gestational age of the preterm and term infants was [30.9 ± 2.8 (n = 14) and 38.8 ± 1.1 (n = 16)] weeks, respectively. Overall CrSO2- was 77.08 ± 9.70% and 71.45 ± 12.74% for the SenSmart and INVOS, respectively (p < 0.001). The correlation coefficient (r) between the CrSO2-SenSmart and INVOS was 0.20 (p < 0.001). The mean difference between the CrSO2-SenSmart and INVOS was 5.63 ± 13.87% with -21.6% to 32.8% limits of agreement. The r and mean difference was 0.39 (p < 0.001) and 8.87 ± 12.58% in preterm infants, and 0.06 (p = 0.27) and 2.79 ± 14.34 in term infants. Conclusion The CrSO2-SenSmart tended to read higher than the CrSO2-INVOS device. There was no correlation between the CrSO2-SenSmart and the CrSO2-INVOS in term infants and it was weak in preterms. Due to imprecise agreement, the CrSO2-SenSmart values are not interchangeable with those of the CrSO2-INVOS.
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Affiliation(s)
- Wariphan Wirayannawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jutharat Amawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattaya Yamsiri
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ashoori M, O'Toole JM, O'Halloran KD, Naulaers G, Thewissen L, Miletin J, Cheung PY, El-Khuffash A, Van Laere D, Straňák Z, Dempsey EM, McDonald FB. Machine Learning Detects Intraventricular Haemorrhage in Extremely Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:917. [PMID: 37371150 DOI: 10.3390/children10060917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To test the potential utility of applying machine learning methods to regional cerebral (rcSO2) and peripheral oxygen saturation (SpO2) signals to detect brain injury in extremely preterm infants. STUDY DESIGN A subset of infants enrolled in the Management of Hypotension in Preterm infants (HIP) trial were analysed (n = 46). All eligible infants were <28 weeks' gestational age and had continuous rcSO2 measurements performed over the first 72 h and cranial ultrasounds performed during the first week after birth. SpO2 data were available for 32 infants. The rcSO2 and SpO2 signals were preprocessed, and prolonged relative desaturations (PRDs; data-driven desaturation in the 2-to-15-min range) were extracted. Numerous quantitative features were extracted from the biosignals before and after the exclusion of the PRDs within the signals. PRDs were also evaluated as a stand-alone feature. A machine learning model was used to detect brain injury (intraventricular haemorrhage-IVH grade II-IV) using a leave-one-out cross-validation approach. RESULTS The area under the receiver operating characteristic curve (AUC) for the PRD rcSO2 was 0.846 (95% CI: 0.720-0.948), outperforming the rcSO2 threshold approach (AUC 0.593 95% CI 0.399-0.775). Neither the clinical model nor any of the SpO2 models were significantly associated with brain injury. CONCLUSION There was a significant association between the data-driven definition of PRDs in rcSO2 and brain injury. Automated analysis of PRDs of the cerebral NIRS signal in extremely preterm infants may aid in better prediction of IVH compared with a threshold-based approach. Further investigation of the definition of the extracted PRDs and an understanding of the physiology underlying these events are required.
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Affiliation(s)
- Minoo Ashoori
- INFANT Research Centre, University College Cork, T12 AK54 Cork, Ireland
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, T12 XF62 Cork, Ireland
| | - John M O'Toole
- INFANT Research Centre, University College Cork, T12 AK54 Cork, Ireland
- Department of Paediatrics and Child Health, School of Medicine, College of Medicine and Health, University College Cork, T12 DC4A Cork, Ireland
| | - Ken D O'Halloran
- INFANT Research Centre, University College Cork, T12 AK54 Cork, Ireland
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, T12 XF62 Cork, Ireland
| | - Gunnar Naulaers
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
- Neonatal Intensive Care, Katholieke Universiteit Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Liesbeth Thewissen
- Neonatal Intensive Care, Katholieke Universiteit Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Miletin
- Paediatric and Newborn Medicine, Coombe Women's Hospital, D08 XW7X Dublin, Ireland
| | - Po-Yin Cheung
- Department of Paediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Afif El-Khuffash
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, D02 P796 Dublin, Ireland
| | - David Van Laere
- Neonatale Intensive Care Unit, Universitair Ziekenhuis, (UZ) Antwerp, Drie Eikenstraat 655, 2650 Antwerp, Belgium
| | - Zbyněk Straňák
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, T12 AK54 Cork, Ireland
- Department of Paediatrics and Child Health, School of Medicine, College of Medicine and Health, University College Cork, T12 DC4A Cork, Ireland
| | - Fiona B McDonald
- INFANT Research Centre, University College Cork, T12 AK54 Cork, Ireland
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, T12 XF62 Cork, Ireland
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Chock VY, Van Meurs KP. Editorial: Advances in the use of neuromonitoring in newborns. Front Pediatr 2023; 11:1215991. [PMID: 37284291 PMCID: PMC10240396 DOI: 10.3389/fped.2023.1215991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
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