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Fedriga M, Martini S, Iodice FG, Sortica da Costa C, Pezzato S, Moscatelli A, Beqiri E, Czosnyka M, Smielewski P, Agrawal S. Cerebral autoregulation in paediatric and neonatal intensive care: A scoping review. J Cereb Blood Flow Metab 2024:271678X241261944. [PMID: 38867574 DOI: 10.1177/0271678x241261944] [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] [Indexed: 06/14/2024]
Abstract
Deranged cerebral autoregulation (CA) is associated with worse outcome in adult brain injury. Strategies for monitoring CA and maintaining the brain at its 'best CA status' have been implemented, however, this approach has not yet developed for the paediatric population. This scoping review aims to find up-to-date evidence on CA assessment in children and neonates with a view to identify patient categories in which CA has been measured so far, CA monitoring methods and its relationship with clinical outcome if any. A literature search was conducted for studies published within 31st December 2022 in 3 bibliographic databases. Out of 494 papers screened, this review includes 135 studies. Our literature search reveals evidence for CA measurement in the paediatric population across different diagnostic categories and age groups. The techniques adopted, indices and thresholds used to assess and define CA are heterogeneous. We discuss the relevance of available evidence for CA assessment in the paediatric population. However, due to small number of studies and heterogeneity of methods used, there is no conclusive evidence to support universal adoption of CA monitoring, technique, and methodology. This calls for further work to understand the clinical impact of CA monitoring in paediatric and neonatal intensive care.
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Affiliation(s)
- Marta Fedriga
- Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOUBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca G Iodice
- Paediatric Cardiac Anaesthesia and Intensive Care Unit, IRCCS, Bambino Gesu' Hospital, Rome, Italy
| | | | - Stefano Pezzato
- Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Shruti Agrawal
- Department of Paediatric Intensive Care, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Tran NN, Chwa JS, Brady KM, Borzage M, Brecht ML, Woon JX, Miner A, Merkel CA, Friedlich P, Peterson BS, Wood JC. Cerebrovascular responses to a 90° tilt in healthy neonates. Pediatr Res 2024; 95:1851-1859. [PMID: 38280952 PMCID: PMC11245387 DOI: 10.1038/s41390-024-03046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/30/2023] [Accepted: 01/07/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Tilts can induce alterations in cerebral hemodynamics in healthy neonates, but prior studies have only examined systemic parameters or used small tilt angles (<90°). The healthy neonatal population, however, are commonly subjected to large tilt angles (≥90°). We sought to characterize the cerebrovascular response to a 90° tilt in healthy term neonates. METHODS We performed a secondary descriptive analysis on 44 healthy term neonates. We measured cerebral oxygen saturation (rcSO2), oxygen saturation (SpO2), heart rate (HR), breathing rate (BR), and cerebral fractional tissue oxygen extraction (cFTOE) over three consecutive 90° tilts. These parameters were measured for 2-min while neonates were in a supine (0°) position and 2-min while tilted to a sitting (90°) position. We measured oscillometric mean blood pressure (MBP) at the start of each tilt. RESULTS rcSO2 and BR decreased significantly in the sitting position, whereas cFTOE, SpO2, and MBP increased significantly in the sitting position. We detected a significant position-by-time interaction for all physiological parameters. CONCLUSION A 90° tilt induces a decline in rcSO2 and an increase in cFTOE in healthy term neonates. Understanding the normal cerebrovascular response to a 90° tilt in healthy neonates will help clinicians to recognize abnormal responses in high-risk infant populations. IMPACT Healthy term neonates (≤14 days old) had decreased cerebral oxygen saturation (~1.1%) and increased cerebral oxygen extraction (~0.01) following a 90° tilt. We detected a significant position-by-time interaction with all physiological parameters measured, suggesting the effect of position varied across consecutive tilts. No prior study has characterized the cerebral oxygen saturation response to a 90° tilt in healthy term neonates.
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Affiliation(s)
- Nhu N Tran
- Institute for the Developing Mind, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Jason S Chwa
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kenneth M Brady
- Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew Borzage
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jessica X Woon
- Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Anna Miner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carlin A Merkel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe Friedlich
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bradley S Peterson
- Institute for the Developing Mind, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John C Wood
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Merkel CA, Brady KM, Votava-Smith JK, Tran NN. A pilot study: Comparing a novel noninvasive measure of cerebrovascular stability index with an invasive measure of cerebral autoregulation in neonates with congenital heart disease. J Clin Transl Sci 2023; 7:e165. [PMID: 37588677 PMCID: PMC10425865 DOI: 10.1017/cts.2023.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 08/18/2023] Open
Abstract
Infants with congenital heart disease (CHD) may have impaired cerebral autoregulation (CA) associated with cerebral fractional tissue oxygen extraction (FTOE). We conducted a pilot study in nine CHD neonates to validate a noninvasive CA measure, cerebrovascular stability index (CSI), by eliciting responses to postural tilts. We compared CSI to an invasive measure of CA and to FTOE collected during tilts (FTOESpot). FTOESpot correlated with CSI, as did the change in FTOE during tilts, but CSI's correlation with impaired CA did not reach significance. Larger trials are indicated to validate CSI, allowing for noninvasive CA measurements and measurements in outpatient settings.
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Affiliation(s)
| | - Kenneth M. Brady
- Division of Cardiac Anesthesia, Northwestern University Feinberg School of Medicine and Ann & Robert H, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jodie K. Votava-Smith
- Keck School of Medicine, Los Angeles, CA, USA
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Nhu N. Tran
- Keck School of Medicine, Los Angeles, CA, USA
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Pérez-Denia L, Claffey P, O'Reilly A, Delgado-Ortet M, Rice C, Kenny RA, Finucane C. Cerebral Oxygenation Responses to Standing in Young Patients with Vasovagal Syncope. J Clin Med 2023; 12:4202. [PMID: 37445237 DOI: 10.3390/jcm12134202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Vasovagal syncope (VVS) is common in young adults and is attributed to cerebral hypoperfusion. However, during active stand (AS) testing, only peripheral and not cerebral hemodynamic responses are measured. We sought to determine whether cerebral oxygenation responses to an AS test were altered in young VVS patients when compared to the young healthy controls. A sample of young healthy adults and consecutive VVS patients attending a Falls and Syncope unit was recruited. Continuous beat-to-beat blood pressure (BP), heart rate, near-infrared spectroscopy (NIRS)-derived tissue saturation index (TSI), and changes in concentration of oxygenated/deoxygenated Δ[O2Hb]/Δ[HHb] hemoglobin were measured. BP and NIRS-derived features included nadir, peak, overshoot, trough, recovery rate, normalized recovery rate, and steady-state. Multivariate linear regression was used to adjust for confounders and BP. In total, 13 controls and 27 VVS patients were recruited. While no significant differences were observed in the TSI and Δ[O2Hb], there was a significantly smaller Δ[HHb] peak-to-trough and faster Δ[HHb] recovery rate in VVS patients, independent of BP. A higher BP steady-state was observed in patients but did not remain significant after multiple comparison correction. Young VVS patients demonstrated a similar cerebral circulatory response with signs of altered peripheral circulation with respect to the controls, potentially due to a hyper-reactive autonomic nervous system. This study sets the grounds for future investigations to understand the role of cerebral regulation during standing in VVS.
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Affiliation(s)
- Laura Pérez-Denia
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Medical Physics, Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 C9X2 Dublin, Ireland
| | - Paul Claffey
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Ailbhe O'Reilly
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Bioengineering, School of Mechanical Engineering, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | | | - Ciara Rice
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Ciarán Finucane
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Medical Physics, Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 C9X2 Dublin, Ireland
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Tran NN, Tran M, Panigrahy A, Brady KM, Votava-Smith JK. Association of Cerebrovascular Stability Index and Head Circumference Between Infants With and Without Congenital Heart Disease. Pediatr Cardiol 2022; 43:1624-1630. [PMID: 35426499 DOI: 10.1007/s00246-022-02891-3] [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: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
Congenital heart disease (CHD) is a common birth defect in the United States. CHD infants are more likely to have smaller head circumference and neurodevelopmental delays; however, the cause is unknown. Altered cerebrovascular hemodynamics may contribute to neurologic abnormalities, such as smaller head circumference, thus we created a novel Cerebrovascular Stability Index (CSI), as a surrogate for cerebral autoregulation. We hypothesized that CHD infants would have an association between CSI and head circumference. We performed a prospective, longitudinal study in CHD infants and healthy controls. We measured CSI and head circumference at 4 time points (newborn, 3, 6, 9 months). We calculated CSI by subtracting the average 2-min sitting from supine cerebral oxygenation (rcSO2) over three consecutive tilts (0-90°), then averaged the change score for each age. Linear regressions quantified the relationship between CSI and head circumference. We performed 177 assessments in total (80 healthy controls, 97 CHD infants). The average head circumference was smaller in CHD infants (39.2 cm) compared to healthy controls (41.6 cm) (p < 0.001) and head circumference increased by 0.27 cm as CSI improved in the sample (p = 0.04) overall when combining all time points. Similarly, head circumference increased by 0.32 cm as CSI improved among CHD infants (p = 0.04). We found CSI significantly associated with head circumference in our sample overall and CHD infants alone, which suggests that impaired CSI may affect brain size in CHD infants. Future studies are needed to better understand the mechanism of interaction between CSI and brain growth.
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Affiliation(s)
- Nhu N Tran
- Division of Neonatology, Children's Hospital Los Angeles (CHLA), Fetal and Neonatal Institute, 4650 Sunset Blvd., MS#137, Los Angeles, CA, 90027, USA. .,Department of Pediatrics, Keck School of Medicine, University of Southern California (KSOM USC), Los Angeles, CA, USA.
| | - Michelle Tran
- Department of Population and Public Health Sciences, KSOM USC, Los Angeles, CA, USA.,Division of Research on Children, Youth, and Families, The Saban Research Institute, CHLA, Los Angeles, CA, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, CHLA, Los Angeles, CA, USA.,University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ken M Brady
- Lurie Children's Hospital of Chicago, Anesthesiology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jodie K Votava-Smith
- Department of Pediatrics, Keck School of Medicine, University of Southern California (KSOM USC), Los Angeles, CA, USA.,Division of Cardiology, Department of Pediatrics, CHLA and KSOM USC, Los Angeles, CA, USA
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Tran NN, Votava-Smith JK, Wood JC, Panigrahy A, Wee CP, Borzage M, Kumar SR, Murray PM, Brecht ML, Paquette L, Brady KM, Peterson BS. Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls. PLoS One 2021; 16:e0251255. [PMID: 33970937 PMCID: PMC8109808 DOI: 10.1371/journal.pone.0251255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Infants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls. Methods We performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting). Results Cerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04). Conclusion CHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants.
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Affiliation(s)
- Nhu N. Tran
- Institute for the Developing Mind, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - Jodie K. Votava-Smith
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - John C. Wood
- Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Ashok Panigrahy
- University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Pediatric Radiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Choo Phei Wee
- Department of Preventive Medicine, Southern California Clinical and Translational Science Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Matthew Borzage
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - S. Ram Kumar
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Paula M. Murray
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Lisa Paquette
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Kenneth M. Brady
- Lurie Children’s Hospital of Chicago, Anesthesiology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Bradley S. Peterson
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
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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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Orthostatic Headache in Children Including Postural Tachycardia Syndrome and Orthostatic Hypotension: A Near-Infrared Spectroscopy Study. J Clin Med 2020; 9:jcm9124125. [PMID: 33371330 PMCID: PMC7767397 DOI: 10.3390/jcm9124125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background and aim: Although head and/or neck pain attributed to orthostatic hypotension is included in international guidelines, its mechanisms and relevance remain unknown. This study examined the term’s relevance and aimed to elucidate the associated clinical features. Methods: An active stand test was performed to evaluate fluctuations in systemic and cerebral circulation in children and adolescents reporting complaints in the absence of a confirmed organic disorder. The subjects were categorized based on orthostatic headache presence/absence, and their characteristics and test results were compared. Results: Postural tachycardia syndrome was observed in 50.0% of children with, and 55.1% without, orthostatic headache. For orthostatic hypotension, the respective values were 31.3% and 30.6%. A history of migraine was more prevalent in children with orthostatic headaches (64.1% vs. 28.6%; p < 0.01). The observed decrease in the cerebral oxygenated hemoglobin level was larger in children with orthostatic headaches (Left: 6.3 (3.2–9.4) vs. 4.1 (0.8–6.1); p < 0.01, Right: 5.3 (3.1–8.6) vs. 4.0 (0.8–5.9); p < 0.01). Conclusion: Fluctuations in cerebral blood flow were associated with orthostatic headaches in children, suggesting that the headaches are due to impaired intracranial homeostasis. As orthostatic headache can have multiple causes, the term “head and/or neck pain attributed to orthostatic (postural) hypotension” should be replaced with a more inclusive term.
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Tran NN, Tran M, Elgabalawy E, Lopez J, Kysh L. The Use of Near-Infrared Spectroscopy (NIRS) to Measure Cerebral Oxygen Saturation During Body Position Changes on Infants Less than One Year Old. J Pediatr Nurs 2020; 55:155-164. [PMID: 32950823 DOI: 10.1016/j.pedn.2020.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the state of the literature for near-infrared spectroscopy (NIRS) to measure cerebral oxygen saturation during body position changes on infants <1 year old. INTRODUCTION Although regional cerebral oxygen saturation is commonly used in critically ill populations, it is not usual practice to tailor care based on differences in the cerebral oxygen saturation during measurements in different body positions. We believe that alterations in cerebral oxygen saturation during position changes can also inform clinicians regarding brain health, such as the regulation of brain blood flow. INCLUSION CRITERIA We included studies in infants <1 year old; who had cerebral oxygen saturation measured in varying positions (e.g. supine versus side-lying). METHODS On March 30, 2019, we searched Medline, Embase, Cochrane CENTRAL, CINAHL, and Web of Science for studies written in English with no restriction on publication dates. We selected studies that involved infants <1 year old and measured cerebral oxygen saturation during varying body positions. RESULTS We found 24 primary studies on 694 infants. The authors investigated whether brain oxygen saturation was influenced by body position. A majority of the studies found a statistically significant difference between cerebral oxygen saturation in various body positions. CONCLUSIONS More research needs to be performed on variations in brain oxygen saturation during body position changes and the correlation with outcomes. Knowledge of brain oxygen saturation can provide clinicians an understanding of the infant's brain health. Healthcare providers may adapt care specifically to improve brain health with NIRS-based brain oxygen saturation monitoring.
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Affiliation(s)
- Nhu N Tran
- Keck School of Medicine of the University of Southern California (KSOM USC), Department of Surgery and Children's Hospital Los Angeles (CHLA), United States.
| | - Michelle Tran
- Department of Preventive Medicine, KSOM USC, United States; Division of Research on Children, Youth, and Families, The Saban Research Institute, CHLA, United States
| | - Eman Elgabalawy
- Division of Research on Children, Youth, and Families, The Saban Research Institute, CHLA, United States
| | - Jeraldine Lopez
- Division of Research on Children, Youth, and Families, The Saban Research Institute, CHLA, United States
| | - Lynn Kysh
- The Institute for Nursing and Interprofessional Research, CHLA, United States
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Cerebral Blood Oxygenation Changes in Juvenile Patients with Delayed Orthostatic Hypotension During an Active Standing Test. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 31893398 DOI: 10.1007/978-3-030-34461-0_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Delayed orthostatic hypotension (OH) is a minor subset of orthostatic dysregulation (OD). Cerebral blood oxygenation in juvenile patients with delayed OH has not been studied. We investigated the bilateral changes in cerebral oxygenation in the prefrontal cortex during an active standing test in 23 juvenile patients with delayed OH using near-infrared spectroscopy (NIRS). We measured the oxy-Hb, deoxy-Hb, and total-Hb during the active standing test. Four observations were made during the test: t1 in a resting supine position, t2 when maintaining blood pressure, and the remaining two (t3, t4) during hypotension. The concentration of oxy-Hb significantly decreased prior to satisfying the diagnostic criteria of delayed OH after standing and did not change thereafter. The concentration of deoxy-Hb increased gradually during the measurement periods. In addition, total-Hb increased from t2 to t3. There was no significant difference in the change in each Hb parameter between the left and right cerebral hemispheres. Our results indicate that NIRS parameters are more sensitive than blood pressure for the interpretation of cerebral autoregulation in juvenile patients with delayed OH.
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Cerebral Autoregulation During Active Standing Test in Juvenile Patients with Instantaneous Orthostatic Hypotension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 31893397 DOI: 10.1007/978-3-030-34461-0_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Instantaneous orthostatic hypotension (INOH) is one of the main types of orthostatic dysregulation in children and adolescents. In patients with INOH arterial pressure drops considerably after active standing and is slow to recover. We investigated changes in cerebral oxygenation in the bilateral prefrontal cortex during an active standing test in juvenile INOH patients to evaluate changes in cerebral oxygen metabolism. We enrolled 82 INOH patients (mean age 13.8 ± 2.2 years, 52 mild and 30 severe patients) at Nihon University Itabashi Hospital from October 2013 to April 2018. We measured cerebral oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin levels in the bilateral prefrontal cortex using near-infrared spectroscopy during an active standing test. In severe INOH patients, cerebral oxygenation of the right prefrontal cortex remained constant when blood pressure dropped; however, de-oxy-Hb significantly increased. These findings confirm that there is asymmetrical autoregulation between the right and left prefrontal cortex.
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Endo A, Fujita Y, Fuchigami T, Takahashi S, Mugishima H, Skatani K. Changes in cerebral blood oxygenation induced by active standing test in children with POTS and NMS. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 812:253-261. [PMID: 24729241 DOI: 10.1007/978-1-4939-0620-8_34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Orthostatic dysregulation (OD) has been classified into subtypes by heart rate and blood pressure; however, the hemodynamics of brains have not yet been revealed. Therefore, we investigated changes in cerebral blood flow and oxygenation during an active standing test to clarify the pathophysiology of two subtypes: postural tachycardia syndrome (POTS) and neurally mediated syncope (NMS). We studied 31 children (15 boys, 16 girls; mean age, 14.0 ± 1.7 years) who presented with OD at the Department of Pediatrics and Child Health, Nihon University School of Medicine between 2009 and 2011. OD was diagnosed using the Japanese clinical guidelines for juvenile orthostatic dysregulation. After a 10-min resting period in the supine position, patients were asked to quickly stand up and keep upright for 10 min. Cerebral blood flow and cerebral oxygenation were measured using transcranial Doppler sonography and near-infrared spectroscopy. POTS showed a significant decrease of oxy-Hb and resistance index (RI), suggesting transient ischemia with maintainable cerebral autoregulation. NMS showed a decrease of oxy-Hb and an increase of RI, suggesting ischemia and impairment of autoregulation.
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Affiliation(s)
- Ayumi Endo
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yukihiko Fujita
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Tatsuo Fuchigami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hideo Mugishima
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kaoru Skatani
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.,Nihon University College of Engineering, Tokyo, Japan
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13
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Asymmetrical Changes in Cerebral Blood Oxygenation Induced by an Active Standing Test in Children with Postural Tachycardia Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 812:271-278. [DOI: 10.1007/978-1-4939-0620-8_36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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14
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Changes in near-infrared spectroscopy and the bispectral index during tilt-table examination. Pediatr Cardiol 2011; 32:234-6. [PMID: 21210097 DOI: 10.1007/s00246-010-9862-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Abstract
The head-upright tilt-table test is an important tool for the diagnosis of vasodepressor or neurocardiogenic syncope. The use of noninvasive near-infrared spectroscopy (NIRS) monitoring and bispectral index (BIS) monitoring during these cases can add another tool to the real-time monitoring and aid in their diagnosis. The authors report their experience using NIRS and BIS monitoring during tilt-table testing to investigate syncope in a 14-year-old adolescent. In this case, changes in the NIRS occurred earlier than changes in either blood pressure or the development of clinical symptoms. The change in the NIRS and BIS values correlated with the patient's level of consciousness. One major advantage of monitors such as the BIS, and more importantly, the NIRS is that they provide an instantaneous and continuous noninvasive measure of cerebral perfusion.
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