1
|
Kooi EMW, Mintzer JP, Rhee CJ, Ergenekon E, Schwarz CE, Pichler G, de Boode WP. Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy : Part of the series on near-infrared spectroscopy by the European Society of Paediatric Research Special Interest Group "Near-Infrared Spectroscopy". Pediatr Res 2024:10.1038/s41390-024-03226-z. [PMID: 38730022 DOI: 10.1038/s41390-024-03226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
In this narrative review, we summarize the current knowledge and applications of somatic near-infrared spectroscopy (NIRS), with a focus on intestinal, renal, limb, and multi-site applications in neonates. Assessing somatic oxygenation at various body locations in neonates may aid in the understanding of underlying pathophysiology of organ injury. Considering cerebral autoregulation may be active to protect the brain during systemic circulatory failure, peripheral somatic oxygenation may potentially provide an early indication of neonatal cardiovascular failure and ultimate hypoxemic injury to vital organs including the brain. Certain intestinal oxygenation patterns appear to be associated with the onset and course of necrotizing enterocolitis, whereas impaired renal oxygenation may indicate the onset of acute kidney injury after various types of hypoxic events. Peripheral muscle oxygenation measured at a limb may be particularly effective in the early prediction of shock in neonates. Using multi-site NIRS may complement current approaches and clinical investigations to alert for neonatal tissue hypoxemia, and potentially even guide management. However, somatic NIRS has its inherent limitations in regard to accuracy. Interpretation of organ-specific values can also be challenging. Last, currently there are limited prospective intervention studies, and clinical benefits need to be examined further, after the clarification of critical threshold-values. IMPACT: The assessment of somatic oxygenation using NIRS may contribute to the prediction of specific diseases in hemodynamically challenged neonates. Furthermore, it may give early warning signs for impending cardiovascular failure, and impaired cerebral circulation and oxygenation. We present a comprehensive overview of the literature on applications of NIRS to various somatic areas, with a focus on its potential clinical applicability, including future research directions. This paper will enable prospective standardized studies, and multicenter collaboration to obtain statistical power, likely to advance the field.
Collapse
Affiliation(s)
- Elisabeth M W Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | | | | | - Christoph E Schwarz
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Maki S, Takakura S, Tsuji M, Magawa S, Tamaishi Y, Nii M, Kaneda M, Yoshida K, Toriyabe K, Kondo E, Ikeda T. Tadalafil for Treatment of Fetal Growth Restriction: A Review of Experimental and Clinical Studies. Biomedicines 2024; 12:804. [PMID: 38672159 PMCID: PMC11047858 DOI: 10.3390/biomedicines12040804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Fetal growth restriction (FGR) is a major concern in perinatal care. Various medications have been proposed as potential treatments for this serious condition. Nonetheless, there is still no definitive treatment. We studied tadalafil, a phosphodiesterase-5 inhibitor, as a therapeutic agent for FGR in clinical studies and animal experiments. In this review, we summarize our preclinical and clinical data on the use of tadalafil for FGR. Our studies in mouse models indicated that tadalafil improved FGR and hypertensive disorders of pregnancy. A phase II trial we conducted provided evidence supporting the efficacy of tadalafil in prolonging pregnancy (52.4 vs. 36.8 days; p = 0.03) and indicated a good safety profile for fetuses and neonates. Fetal, neonatal, and infant mortality was significantly lower in mothers receiving tadalafil treatment than that in controls (total number: 1 vs. 7, respectively; p = 0.03), and no severe adverse maternal events associated with tadalafil were observed. Although further studies are needed to establish the usefulness of tadalafil in FGR treatment, our research indicates that the use of tadalafil in FGR treatment may be a paradigm shift in perinatal care.
Collapse
Affiliation(s)
- Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan; (S.T.); (M.T.); (S.M.); (Y.T.); (M.N.); (M.K.); (K.Y.); (K.T.); (E.K.); (T.I.)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
McKinlay CJD, Anderson C, Cheong JLY, Gordon A, Harris SL, Hurrion EM, Ireland S, Koorts P, Lui K, Mackay L, Oakes-Ter Bals M, Opie G, Sharp M, Groom KM. Childhood outcomes after maternal antenatal sildenafil treatment for severe early-onset fetal growth restriction: a randomized trial (STRIDER NZAus). J Perinatol 2024; 44:396-403. [PMID: 38057497 DOI: 10.1038/s41372-023-01838-7] [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: 07/07/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
In this follow-up at 2.5 years of children from the STRIDER NZAus Trial (N = 112), in which women with singleton pregnancies affected by severe early fetal growth restriction were randomized to sildenafil citrate 75 mg daily or placebo until 32 weeks, there was no difference between groups in survival without neurosensory impairment, defined as any of cerebral palsy, deafness, blindness, cognitive delay (Bayley III cognition or language score >1 SD below mean) or motor delay: 30/56[54%] vs. 34/56[61%]; aOR = 0.74, 95%CI: 0.31, 1.77. However, children exposed to sildenafil appeared to be more likely to have cognitive delay (13/45[29%] vs. 4/40[10%]; aOR = 3.71, 95% CI: 1.01, 13.63) but less likely to have emotional-behavioural difficulties (2/43[5%] vs. 8/38[21%]; aOR = 0.19, 95%CI: 0.03, 1.00). Conclusion: maternal sildenafil treatment for severe early-onset FGR was not associated with altered survival free of neurosensory impairment at 2.5 years' corrected age.
Collapse
Affiliation(s)
- Christopher J D McKinlay
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand.
| | - Chad Anderson
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - Jeanie L Y Cheong
- Royal Women's Hospital, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Sarah L Harris
- University of Otago, Christchurch, New Zealand
- Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Elizabeth M Hurrion
- Mater Mothers' Hospital, Brisbane, QLD, Australia
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Susan Ireland
- Townsville University Hospital, Townsville, QLD, Australia
| | - Pieter Koorts
- Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Kei Lui
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Laura Mackay
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Gillian Opie
- Mercy Hospital for Women, Melbourne, VIC, Australia
| | - Mary Sharp
- King Edward Memorial Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Katie M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
4
|
Tsuji M, Maki S, Enomoto N, Okamoto K, Kitamura A, Magawa S, Takakura S, Nii M, Tanaka K, Yodoya N, Tanaka H, Sawada H, Kondo E, Hirayama M, Ikeda T. Fetal Biometric Assessment and Infant Developmental Prognosis of the Tadalafil Treatment for Fetal Growth Restriction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050900. [PMID: 37241131 DOI: 10.3390/medicina59050900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Tadalafil is expected to treat fetal growth restriction (FGR), a risk factor for stillbirth and neonatal morbidity. This study aimed to evaluate the fetal biometric growth pattern of fetuses with FGR treated with tadalafil by ultrasonographic assessment. Materials and Methods: This was a retrospective study. Fifty fetuses diagnosed with FGR and treated by maternal administration of tadalafil and ten controls who received conventional treatment at Mie University Hospital from 2015 to 2019 were assessed. Fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW) at the start of treatment and at two weeks and four weeks of treatment were mainly assessed by ultrasound examination. The Wilcoxon signed-rank test was used to assess the measures. The Kyoto Scale of Psychological Development (KSPD) was used to assess the developmental prognosis on tadalafil-treated children at 1.5 years of corrected age (CA) and 3 years old. Results: The median gestational age at the start of treatment was 30 and 31 weeks in the tadalafil and control groups, respectively, and the median gestational age at delivery was 37 weeks in both groups. The Z-score of HC was significantly increased at 4 weeks of treatment (p = 0.005), and the umbilical artery resistance index was significantly decreased (p = 0.049), while no significant difference was observed in the control group. The number of cases with an abnormal score of less than 70 on the KSPD test was 19% for P-M, 8% for C-A, 19% for L-S, and 11% for total area at 1.5 years CA. At 3 years old, the respective scores were 16%, 21%, 16%, and 16%. Conclusions: Tadalafil treatment for FGR may maintain fetal HC growth and infants' neuro-developmental prognosis.
Collapse
Affiliation(s)
- Makoto Tsuji
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Kota Okamoto
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Asa Kitamura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Noriko Yodoya
- Department of Pediatrics, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Hirofumi Sawada
- Department of Pediatrics, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| |
Collapse
|
5
|
De Bie FR, Basurto D, Kumar S, Deprest J, Russo FM. Sildenafil during the 2nd and 3rd Trimester of Pregnancy: Trials and Tribulations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11207. [PMID: 36141480 PMCID: PMC9517616 DOI: 10.3390/ijerph191811207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Sildenafil, a phosphodiesterase 5 inhibitor with a vasodilatory and anti-remodeling effect, has been investigated concerning various conditions during pregnancy. Per indication, we herein review the rationale and the most relevant experimental and clinical studies, including systematic reviews and meta-analyses, when available. Indications for using sildenafil during the second and third trimester of pregnancy include maternal pulmonary hypertension, preeclampsia, preterm labor, fetal growth restriction, oligohydramnios, fetal distress, and congenital diaphragmatic hernia. For most indications, the rationale for administering prenatal sildenafil is based on limited, equivocal data from in vitro studies and rodent disease models. Clinical studies report mild maternal side effects and suggest good fetal tolerance and safety depending on the underlying pathology.
Collapse
Affiliation(s)
| | - David Basurto
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Sailesh Kumar
- Mater Research Institute and School of Medicine, University of Queensland, Brisbane, QLD 4343, Australia
| | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, 3000 Leuven, Belgium
| | - Francesca Maria Russo
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, 3000 Leuven, Belgium
| |
Collapse
|
6
|
Maki S, Tanaka H, Takakura S, Nii M, Tanaka K, Ogura T, Kotera M, Nishimura Y, Tamaru S, Ushida T, Tanaka Y, Kikuchi N, Kinjo T, Kawamura H, Takano M, Nakamura K, Suga S, Kasai M, Yasui O, Nagao K, Maegawa Y, Kotani T, Endo M, Yasuhi I, Aoki S, Aoki Y, Yoshida Y, Nakata M, Sekizawa A, Ikeda T. Tadalafil treatment for fetuses with early-onset growth restriction: a protocol for a multicentre, randomised, placebo-controlled, double-blind phase II trial (TADAFER IIb). BMJ Open 2022; 12:e054925. [PMID: 35701067 PMCID: PMC9198796 DOI: 10.1136/bmjopen-2021-054925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION TheTADAlafil treatment for Fetuses with early-onset growth Restriction: multicentrer, randomizsed, phase II trial (TADAFER II) study showed the possibility of prolonging the pregnancy period in cases of early-onset fetal growth restriction; however, it was an open-label study. To establish further evidence for the efficacy of tadalafil in this setting, we planned a multicentre, randomised, placebo-controlled, double-blind trial. METHODS AND ANALYSIS This trial will be conducted in 180 fetuses with fetal growth restriction enrolled from medical centres in Japan; their mothers will be randomised into three groups: arm A, receiving two times per day placebo; arm B, receiving one time per day 20 mg tadalafil and one time per day placebo and arm C, receiving 20 mg two times per day tadalafil. The primary endpoint is the prolongation of gestational age at birth, defined as days from the first day of the protocol-defined treatment to birth. To minimise bias in terms of fetal baseline conditions and timing of delivery, a fetal indication for delivery as in TADAFER II will be established in this trial. The investigator will evaluate fetal baseline conditions at enrolment and decide the timing of delivery based on this indication. ETHICS AND DISSEMINATION This study has been approved by Mie University Hospital Clinical Research Review Board on 22 July 2019 (S2018-007). Written informed consent will be obtained from all mothers before recruitment. Our findings will be widely disseminated through peer-reviewed publications. TRIAL REGISTRATION jRCTs041190065.
Collapse
Affiliation(s)
- Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Toru Ogura
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Mayumi Kotera
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Yuki Nishimura
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Satoshi Tamaru
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhiro Tanaka
- Department of Obstetrics and Gynecology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Norihiko Kikuchi
- Department of Obstetrics and Gynecology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Tadatsugu Kinjo
- Department of Obstetrics and Gynecology, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Hiroshi Kawamura
- Department of Obstetrics and Gynecology, Fukui University Graduate School of Medicine, Fukui, Japan
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Otaku, Tokyo, Japan
| | - Koji Nakamura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Michi Kasai
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Osamu Yasui
- Department of Obstetrics and Gynecology, Showa University Graduate School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Kenji Nagao
- Department of Obstetrics and Gynecology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yuka Maegawa
- Department of Obstetrics and Gynecology, Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Fukui University Graduate School of Medicine, Fukui, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Otaku, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University Graduate School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| |
Collapse
|