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Cai L, Zhao E, Niu H, Liu Y, Zhang T, Liu D, Zhang Z, Li J, Qiao P, Lv H, Ren P, Zheng W, Wang Z. A machine learning approach to predict cerebral perfusion status based on internal carotid artery blood flow. Comput Biol Med 2023; 164:107264. [PMID: 37481951 DOI: 10.1016/j.compbiomed.2023.107264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Cerebral blood flow (CBF), or perfusion, is a prerequisite for maintaining brain metabolism and normal physiological functions. Diagnosing and evaluating cerebral perfusion status is crucial to managing brain disease. However, cerebral perfusion imaging devices are complicated to operate, should be controlled by specialized technicians, are often large, and are usually installed in fixed places such as hospitals. It is significantly difficult for clinicians to obtain the cerebral perfusion status in time. Considering that CBF is mainly supplied by the internal carotid artery (ICA), this study proposes a cerebral perfusion status prediction model that can automatically quantify the level of cerebral perfusion in patients by modeling the association between ICA blood flow and cerebral perfusion. MATERIALS AND METHODS Forty-eight participants were enrolled in the study after screening. We collected participants' ICA ultrasound and brain magnetic resonance imaging (MRI) data before and after dobutamine injection based on a rigorous experimental paradigm and built an ICA-cerebral perfusion datasetdd. Support vector machine (SVM), k-nearest neighbor (KNN), decision tree (DT), random forest (RF), gradient boosting decision tree (GBDT), and extreme gradient boosting (XGBOOST) were used for early prediction of cerebral perfusion status. The SHAP analysis was adopted to reveal the impact of interpretable predictions for each feature. RESULTS The XGBOOST model demonstrated the best overall classification performance with an accuracy of 78.01%, sensitivity of 96.67%, specificity of 98.23%, F1 score of 74.57%, Matthews correlation coefficient (MCC) of 62.17%, and area under the receiver operating characteristic curve (AUC) of 87.08%. Accelerated speed, peak systolic flow velocity, and resistance index of ICA blood flow are important factors for cerebral perfusion prediction. CONCLUSIONS The proposed method paves a new avenue for the study of predicting cerebral perfusion status automatically and providesv a noninvasive, real-time, and low-cost alternative to brain perfusion imaging. Moreover, this analysis identifies highly predictive features for the cerebral perfusion status and gives clinicians an intuitive understanding of the influence of key features. The prediction models can serve as an early warning tool that offers sufficient time for clinicians to take early intervention measures.
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Affiliation(s)
- Linkun Cai
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
| | - Erwei Zhao
- National Space Science Center, Chinese Academy of Sciences, 100190, Beijing, China.
| | - Haijun Niu
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Yawen Liu
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Tingting Zhang
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Dong Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Zhe Zhang
- China Astronaut Research and Training Center, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Penggang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China.
| | - Wei Zheng
- National Space Science Center, Chinese Academy of Sciences, 100190, Beijing, China.
| | - Zhenchang Wang
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China; Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China.
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Szostek AS, Saunier C, Elsensohn MH, Boucher P, Merquiol F, Gerst A, Portefaix A, Chassard D, De Queiroz Siqueira M. Effective dose of ephedrine for treatment of hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age: a multicentre randomised, controlled, open label, dose escalation trial. Br J Anaesth 2023; 130:603-610. [PMID: 36639328 DOI: 10.1016/j.bja.2022.12.006] [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: 07/19/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The recommended dose of ephedrine in adults (0.1 mg kg-1) frequently fails to treat hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age. The aim of this study was to determine the optimal dose of ephedrine in this population for the treatment of hypotension after induction of general anaesthesia with sevoflurane. METHODS We conducted a multicentre, prospective, randomised, open-label, controlled, dose-escalation trial. Subjects were randomised if presenting a >20% change from baseline in MAP. Six cohorts of 20 subjects each were enrolled. Ten subjects in the first cohort received 0.1 mg kg-1 i. v. (reference dose). For each subsequent cohort, 10 subjects were assigned to the next higher dose (consecutively 0.6, 0.8, 1, 1.2, and 1.4 mg kg-1 i. v.), and the other subjects were assigned to one or more doses already investigated in previous cohorts. The primary outcome was the return of MAP to >80% of baseline at least once within 10 min after ephedrine administration. RESULTS A total of 119 infants (25% females), with a mean age (standard deviation) of 2.7 (1.3) months, received their allocated dose of ephedrine. The optimal dose of ephedrine was 1.2 mg kg-1, with a percentage of success of 65.5% (95% confidence interval, 35.6-86.4). The doses of ephedrine investigated did not induce adverse events. CONCLUSIONS Doses of ephedrine much higher (∼10-fold) than those used in adults are necessary in neonates and infants for the treatment of hypotension after induction of general anaesthesia with sevoflurane. CLINICAL TRIAL REGISTRATION NCT02384876.
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Affiliation(s)
- Anne-Sara Szostek
- Department of Paediatric Anaesthesia, Hospices Civils de Lyon, Bron, France
| | - Clarisse Saunier
- Department of Epidemiology, Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Bron, France
| | - Mad-Hélénie Elsensohn
- Department of Biostatistics, Hospices Civils de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Pierre Boucher
- Department of Paediatric Anaesthesia, Hospices Civils de Lyon, Bron, France
| | - Fanette Merquiol
- Department of Anaesthesia, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Adeline Gerst
- Department of Anaesthesia, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Portefaix
- Department of Epidemiology, Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Bron, France; Department of Biostatistics, Hospices Civils de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Dominique Chassard
- Department of Anaesthesia, Hospices Civils de Lyon, Université Lyon 1, Bron, France.
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The cerebral haemodynamic response to somatosensory stimulation in preterm newborn lambs is reduced following intrauterine inflammation and dopamine infusion. Exp Neurol 2022; 352:114049. [DOI: 10.1016/j.expneurol.2022.114049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/01/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022]
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Ovsenik A, Podbregar M, Fabjan A. Cerebral blood flow impairment and cognitive decline in heart failure. Brain Behav 2021; 11:e02176. [PMID: 33991075 PMCID: PMC8213942 DOI: 10.1002/brb3.2176] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Cognitive decline is an important contributor to disability in patients with chronic heart failure, affecting 25%-50% of patients. The aim of this review is to stress the importance of understanding pathophysiological mechanisms of heart failure involved in cognitive decline. METHODS An extensive PubMed search was conducted for the literature on the basic mechanisms of cerebral blood flow regulation, the effect of cardiac dysfunction on cerebral blood flow, and possible mechanisms underlying the association between cardiac dysfunction and cognitive decline. RESULTS Published literature supports the thesis that cardiac dysfunction leads to cerebral blood flow impairment and predisposes to cognitive decline. One of the postulated mechanisms underlying cognitive decline in chronic heart failure is chronic regional hypoperfusion of critical brain areas. Cognitive function may be further compromised by microvascular damage due to cardiovascular risk factors. Furthermore, it is implied that cerebral blood flow assessment could enable early recognition of patients at risk and help guide appropriate therapeutic strategies. CONCLUSION Interdisciplinary knowledge in the fields of neurology and cardiology is essential to clarify heart and brain interconnections in chronic heart failure. Understanding and identifying the basic neuropathophysiological changes in chronic heart failure could help with developing methods for early recognition of patients at risk, followed by institution of therapeutic actions to prevent or decrease cognitive decline.
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Affiliation(s)
- Ana Ovsenik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Podbregar
- Faculty of Medicine, Department for Internal Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Intensive care, General Hospital Celje, Celje, Slovenia
| | - Andrej Fabjan
- Faculty of Medicine, Institute for Physiology, University of Ljubljana, Ljubljana, Slovenia.,Department of Vascular Neurology and Intensive Care, Neurological Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Inocencio IM, Tran NT, Khor SJ, Wiersma M, Nakamura S, Walker DW, Wong FY. The cerebral haemodynamic response to somatosensory stimulation in preterm newborn lambs is reduced with dopamine or dobutamine infusion. Exp Neurol 2021; 341:113687. [PMID: 33713656 DOI: 10.1016/j.expneurol.2021.113687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the adult brain, increases in neural activity lead to increases in local blood flow. However, in the preterm neonate, studies of cerebral functional haemodynamics have yielded inconsistent results, including negative responses suggesting decreased perfusion and localised tissue hypoxia, probably due to immature neurovascular coupling. Furthermore, the impact of vasoactive medications, such as dopamine and dobutamine used as inotropic therapies in preterm neonates, on cerebrovascular responses to somatosensory input is unknown. We aimed to characterise the cerebral haemodynamic functional response after somatosensory stimulation in the preterm newborn brain, with and without dopamine or dobutamine treatment. METHODS We studied the cerebral haemodynamic functional response in 13 anaesthetised preterm lambs, using near infrared spectroscopy to measure changes in cerebral oxy- and deoxyhaemoglobin (ΔoxyHb, ΔdeoxyHb) following left median nerve stimulation using stimulus trains of 1.8, 4.8 and 7.8 s. The 4.8 and 7.8 s stimulations were repeated during dopamine or dobutamine infusion. RESULTS Stimulation always produced a somatosensory evoked response. Majority of preterm lambs demonstrated positive functional responses (i.e. increased ΔoxyHb) in the contralateral cortex following stimulus trains of all durations. Dopamine increased baseline oxyHb and total Hb, whereas dobutamine increased baseline deoxyHb. Both dopamine and dobutamine reduced the evoked ΔoxyHb responses to 4.8 and 7.8 s stimulations. CONCLUSIONS Somatosensory stimulation increases cerebral oxygenation in the preterm brain, consistent with increased cerebral blood flow due to neurovascular coupling. Notably, our results show that dopamine/dobutamine reduces oxygen delivery relative to consumption in the preterm brain during somatosensory stimulations, suggesting there may be a risk of intermittent localised tissue hypoxia which has clear implications for clinical practice and warrants further investigation.
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Affiliation(s)
- Ishmael M Inocencio
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Nhi T Tran
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; School of Health & Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Song J Khor
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Manon Wiersma
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Shinji Nakamura
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - David W Walker
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; School of Health & Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Flora Y Wong
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; Monash Newborn, Monash Medical Centre, Melbourne, Australia.
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Lima RO, Ribeiro AP, Juliano Y, França CN, de Souza PC. Survival prognosis of newborns from an intensive care unit through the SNAP-PE II risk score. Clinics (Sao Paulo) 2020; 75:e1731. [PMID: 32785568 PMCID: PMC7410358 DOI: 10.6061/clinics/2020/e1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Although child mortality has declined significantly in recent decades, the reduction of neonatal mortality remains a major challenge as neonatal mortality represents 2/3 of the mortality rate in this population. The objective of this study was to evaluate the utility of the Score for Neonatal Acute Physiology Perinatal Extension II (SNAP-PE II) score for evaluating the survival prognosis of newborns admitted to a neonatal intensive care unit (NICU). METHODS The study design involved an observational cross-sectional retrospective collection, as well as a prospective component. The sample included all newborns admitted to the NICU validated by the SNAP-PE II tool from January 1 to December 31, 2014. RESULTS A predominance of young mothers (25.4 years), underwent prenatal care (86.2%), however a considerable percentage (49.4%) of mothers received insufficient medical consultation (less than six consults during their pregnancy). A prevalence of male admissions (62.4%) were noted in the NICU. Premature (61.7%) and underweight (weight <2,500 grams) newborns were also prevalent. The SNAP-PE II score showed an association between the infants who were discharged from the neonatal unit and the non-survivors. An increased prevalence of low birth weight and hypothermia was noted in the group of non-survivors. The mean arterial pressure appears to be a significant risk factor in the newborn group that progressed to death. Hypothermia, mean arterial pressure, and birth weight were the most significant variables associated with death. CONCLUSION The SNAP-PE II was a beneficial indicator of neonatal mortality. The prevention of prematurity and hypothermia by improving maternity care and newborn care can decisively influence neonatal mortality.
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Affiliation(s)
- Renato Oliveira Lima
- Programa de Pos-Graduacao em Ciencias da Saude, Universidade de Santo Amaro (UNISA), Sao Paulo, SP, BR
| | - Ana Paula Ribeiro
- Programa de Pos-Graduacao em Ciencias da Saude, Universidade de Santo Amaro (UNISA), Sao Paulo, SP, BR
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Yara Juliano
- Programa de Pos-Graduacao em Ciencias da Saude, Universidade de Santo Amaro (UNISA), Sao Paulo, SP, BR
| | - Carolina Nunes França
- Programa de Pos-Graduacao em Ciencias da Saude, Universidade de Santo Amaro (UNISA), Sao Paulo, SP, BR
| | - Patrícia Colombo de Souza
- Programa de Pos-Graduacao em Ciencias da Saude, Universidade de Santo Amaro (UNISA), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Abdul Aziz AN, Thomas S, Murthy P, Rabi Y, Soraisham A, Stritzke A, Kamaluddeen M, Al-Awad E, Mohammad K. Early inotropes use is associated with higher risk of death and/or severe brain injury in extremely premature infants. J Matern Fetal Neonatal Med 2019; 33:2751-2758. [PMID: 30563374 DOI: 10.1080/14767058.2018.1560408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Extremely premature infants are susceptible to fluctuations in cerebral blood flow due to immaturity of cerebral autoregulation. Inotropes may cause rapid changes to systemic blood pressure and consequently cerebral blood flow, especially within the first 72 hours of life. This period is recognized to carry the greatest risk for cerebral hemorrhage. This study evaluates the incidence of death and/or severe brain injury in extremely preterm infants treated with inotropes in the first 72 hours of life.Methods: Prospective cohort study of infants born ≤29+0 weeks gestational age (GA) between January 2013 and December 2016. Severe brain injury was defined based on head ultrasound as presence of: grade III or IV intraventricular hemorrhage (IVH), moderate to severe post-hemorrhagic ventricular dilatation (PHVD), or cystic periventricular leukomalacia (cPVL). The association between inotrope use and death and/or brain injury was explored via logistic regression controlling for predefined confounding risk factors.Results: Of 497 eligible infants, 97 (19.5%) received inotropes during the first 72 hours. GA at birth, birth weight (BW), and 5-minute Apgar scores were lower among infants who received early inotropes compared to those not treated with inotropes. A stepwise logistic regression of the predefined confounding factors showed GA, exposure for antenatal steroids, and admission hypothermia to be significant confounding factors. Adjusting for those factors, early use of inotropes was associated with increased risk of death and/or severe brain injury (AOR 4.5; 95%CI: 2.4-8.5), severe brain injury (AOR 4.2; 95% CI: 1.9-8.9), and IVH of any grade (AOR 2.9; 95%CI: 1.7-4.9).Conclusion: Early inotropes use was associated with higher risk of death and/or severe brain injury. Strict indications and strategies for minimizing inotrope use while preventing hypotension should be implemented in the early postnatal care of infants at risk for severe brain injury.
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Affiliation(s)
- Ahmad Nizar Abdul Aziz
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Sumesh Thomas
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Yacov Rabi
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Amuchou Soraisham
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Amelie Stritzke
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Majeeda Kamaluddeen
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Essa Al-Awad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
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Carrapato MRG, Andrade T, Caldeira T. Hypotension in small preterms: what does it mean? J Matern Fetal Neonatal Med 2018; 32:4016-4021. [PMID: 29848160 DOI: 10.1080/14767058.2018.1481034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Introduction: Small preterms often have low blood pressure readings in the first few days of life. However, what is hypotension in preterms? Should there be an aggressive approach to its management? What are the immediate and long-term side effects of powerful medications? Alternatively, could a low blood pressure be accepted instead? Materials and methods: Data were collected from files of all live babies with gestational age (GA) between 230/7 and 316/7 weeks over two different periods: years 2000-2004 and 2008-2012. Results: Our data show that, despite extremely low gestational age (ELGA)/extremely low birth weight (ELBW) neonates, almost half of these tiny babies have neither low mean arterial pressure (MAP) readings nor clinical signs of impaired perfusion. Yet, many of them are, variously treated or not, depending on individual decisions, rather than on sound evidence. Discussion: We suggest, should it be required to treat persistent hypotension, rather than treating just a low MAP recording, to address the whole issue of hypotension in the overall picture of clinical settings; we to assess organ dysfunction caused by low output and use the least aggressive measures, preferably within written protocols, tailored to the given unit, but equally, sufficiently flexible to individual babies. Furthermore, allow for "permissive hypotension" especially if transient, in the absence of clinical signs of hypoperfusion, with normal superior vena cava (SVC) flow, normal cardiac output, and normal brain scanning with normal cerebral Doppler flows. Whether treating hypotension, by whichever definition, "per se", will make any difference to both, immediate and late outcomes; in the end, treating remains open to questioning and calls for careful follow-up of these very susceptible preterms.
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Affiliation(s)
- Manuel R G Carrapato
- São Sebastião Hospital , Santa Maria Feira , Portugal.,Faculty of Health Sciences, University Fernando Pessoa , Porto , Portugal
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Elsayed YN, Amer R, Seshia MM. The impact of integrated evaluation of hemodynamics using targeted neonatal echocardiography with indices of tissue oxygenation: a new approach. J Perinatol 2017; 37:527-535. [PMID: 28102856 DOI: 10.1038/jp.2016.257] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study the impact of integrated evaluation of hemodynamics (IEH) using targeted neonatal echocardiography, together with regional tissue oxygenation, fractional oxygen extraction using near-infrared spectroscopy on the management of infants with compromised hemodynamics. STUDY DESIGN Retrospective cohort comparison of two groups of infants with compromised hemodynamics. EPOCH 1: did not undergo IEH (January 2012 to March 2014); EPOCH 2: underwent IEH (April 2014 to December 2015). The primary outcome was the time to recovery. RESULTS In all, 340 infants were included; 158 underwent IEH with a median (IQR) of 2 (1 to 3) evaluations per infant. Reasons for assessment included PDA (60%), compromised systemic circulation (14%) and clinically suspected pulmonary hypertension (22%). The time to recovery was shorter in IEH group in patients with compromised systemic circulation median (IQR), 32 h (24 to 63) compared with none IEH group 71 h (36 to 96), pulmonary hypertension 63 h (14.2 to 102) in IEH group compared with 68 h (24 to 240) in none IEH group, there were fewer PDA-related complications in preterm infants with PDA in IEH group. CONCLUSION IEH was associated with shorter time to clinical recovery in infants with compromised hemodynamics.
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Affiliation(s)
- Y N Elsayed
- Section of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R Amer
- Section of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M M Seshia
- Section of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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10
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Szpecht D, Szymankiewicz M, Nowak I, Gadzinowski J. Intraventricular hemorrhage in neonates born before 32 weeks of gestation-retrospective analysis of risk factors. Childs Nerv Syst 2016; 32:1399-404. [PMID: 27236782 PMCID: PMC4967094 DOI: 10.1007/s00381-016-3127-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intraventricular hemorrhage (IVH) affects 15-20 % of babies born before 32 weeks of pregnancy. A lot of risk factors of developing IVH are known. The making appropriate recommendations for dealing with infant born less than 32 weeks of gestation aimed at reducing the incidence of IVH is still needed. The study aim was to determine the incidence and analyze risk factors of IVH stage 3 and 4 in infants born before 32 + 0 weeks of pregnancy. METHODS The retrospective analysis of 267 preterm babies (24 to 32 weeks of gestation) hospitalized in 2011-2013 at Department of Neonatology, Poznan University of Medical Sciences was performed. The diagnosis of IVH was confirmed by ultrasound scans according to Papille criteria. Stage 3 and 4 of IVH was confirmed in 14 (25 %) newborns from 23 to 24 weeks of gestation; 21 (37.5 %) from 25 to 26 weeks of gestation; 11 (19.6 %) from 27 to 28 weeks of gestation; 9 (16.1 %) from 29 to 30 weeks of gestation; and 1 (1.8 %) from 31 to 32 weeks of gestation. RESULT The incidence of IVH stage 3 and 4 was higher in children: with less use of AST (OR 1.27; 0.62-2.61), born out of third-level hospitals (OR 2.25; 1.23-4.08), born with asphyxia (OR 3.46; 1.8-6.64), with acidosis treated with NaHCO3 (OR 6.67; 3.78-11.75), those who in the first days of life were treated for hypotension (OR 9.92; 5.12-19.21). CONCLUSION No or uncompleted antenatal steroid therapy increased probability for development of severe intraventricular hemorrhage. Antenatal steroids therapy should be promoted among women at risk of a premature delivery. Hypotension therapy with catecholamines and acidosis with sodium hydrogen carbonate should be carefully considered. The use of appropriate prophylaxis of perinatal (antenatal steroids therapy women at risk of preterm birth, limiting the indications for the use of catecholamines for hypotension treatment and sodium hydrogen carbonate for acidosis therapy, limitation of preterm deliveries outside tertiary referral centeres) significantly reduces the incidence of intraventricular hemorrhage stage 3 and 4. The significance of intraventricular hemorrhage creates a need to carry out periodical analysis, at regional level, concerning its incidence, causes and effects to improve local treatment outcomes by identifying further courses of action.
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Affiliation(s)
- Dawid Szpecht
- Chair and Department of Neonatology, Poznan University of Medical Sciences, Polna 33 Street, 60-535, Poznań, Poland.
| | - Marta Szymankiewicz
- Chair and Department of Neonatology, Poznan University of Medical Sciences, Polna 33 Street, 60-535, Poznań, Poland
| | - Irmina Nowak
- Poznan University of Medical Sciences, Poznań, Poland
| | - Janusz Gadzinowski
- Chair and Department of Neonatology, Poznan University of Medical Sciences, Polna 33 Street, 60-535, Poznań, Poland
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Eriksen VR, Hahn GH, Greisen G. Cerebral autoregulation in the preterm newborn using near-infrared spectroscopy: a comparison of time-domain and frequency-domain analyses. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:037009. [PMID: 25806662 DOI: 10.1117/1.jbo.20.3.037009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/05/2015] [Indexed: 05/23/2023]
Abstract
The aim was to compare two conventional methods used to describe cerebral autoregulation (CA): frequency-domain analysis and time-domain analysis. We measured cerebral oxygenation (as a surrogate for cerebral blood flow) and mean arterial blood pressure (MAP) in 60 preterm infants. In the frequency domain, outcome variables were coherence and gain, whereas the cerebral oximetry index (COx) and the regression coefficient were the outcome variables in the time domain. Correlation between coherence and COx was poor. The disagreement between the two methods was due to the MAP and cerebral oxygenation signals being in counterphase in three cases. High gain and high coherence may arise spuriously when cerebral oxygenation decreases as MAP increases; hence, time-domain analysis appears to be a more robust—and simpler—method to describe CA.
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Affiliation(s)
- Vibeke R Eriksen
- Copenhagen University Hospital-Rigshospitalet, Department of Neonatology, Blegdamsvej 9, 2100 Copenhagen, DenmarkbUniversity of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3, Copenhagen, Denmark
| | - Gitte H Hahn
- Copenhagen University Hospital-Rigshospitalet, Department of Neonatology, Blegdamsvej 9, 2100 Copenhagen, DenmarkcCopenhagen University Hospital-Rigshospitalet, Department of Paediatrics and Adolescent Medicine, Blegdamsvej 9, Copenhagen, Denmark
| | - Gorm Greisen
- Copenhagen University Hospital-Rigshospitalet, Department of Neonatology, Blegdamsvej 9, 2100 Copenhagen, Denmark
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12
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Zhang Y, Zhang C, Zhong X, Zhu D. Quantitative evaluation of SOCS-induced optical clearing efficiency of skull. Quant Imaging Med Surg 2015; 5:136-42. [PMID: 25694963 DOI: 10.3978/j.issn.2223-4292.2014.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND In vivo cortex optical imaging methods for visualization of both structural and functional architecture with high spatial-temporal resolution have shown tremendous advantages in the studies on neurons, glia and microvasculature. To overcome the strong scattering of skull above the cortex, several chronic cranial windows were proposed through craniotomy, but there are some problems. Here, an innovative skull optical clearing solution (SOCS) has been invented to make the skull transparent within 25 min, but SOCS-induced optical clearing efficacy of skull is to be evaluated. METHODS Based on the measurements of divergence of beam spot, collimated transmittance of skull, the efficiency of skull optical clearing has been further evaluated quantitatively by comparing with the Monte Carlo simulation. RESULTS The results show that the light beam bandwidth is 5.2±0.3 mm through the initial skull, and reduces to 2.0±0.2 mm trough the treated skull with SOCS; and the calculated scattering coefficient almost decreases to one third after the treatment. CONCLUSIONS The quantitative evaluation of SOCS-induced optical clearing efficacy of skull provides an important reference for performing transcranial cortical optical imaging or operation based on skull optical clearing technique.
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Affiliation(s)
- Yang Zhang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Wuhan 430074, China ; Key Laboratory of Biomedical Photonics of Ministry of Education, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Chao Zhang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Wuhan 430074, China ; Key Laboratory of Biomedical Photonics of Ministry of Education, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xiewei Zhong
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Wuhan 430074, China ; Key Laboratory of Biomedical Photonics of Ministry of Education, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Dan Zhu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Wuhan 430074, China ; Key Laboratory of Biomedical Photonics of Ministry of Education, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
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13
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Eriksen VR, Hahn GH, Greisen G. Dopamine therapy is associated with impaired cerebral autoregulation in preterm infants. Acta Paediatr 2014; 103:1221-6. [PMID: 25266994 DOI: 10.1111/apa.12817] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/27/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Abstract
AIM Hypotension is a common problem in newborn infants and is associated with increased mortality and morbidity. Dopamine is the most commonly used antihypotensive drug therapy, but has never been shown to improve neurological outcomes. This study tested our hypothesis that dopamine affects cerebral autoregulation (CA). METHODS Near-infrared spectroscopy was used to measure the cerebral oxygenation index in 60 very preterm infants, and mean arterial blood pressure was monitored towards the end of their first day of life. Measurements were performed continuously for two to three hour periods. CA was quantified as the cerebral oximetry index (COx). RESULTS We treated 13 of the 60 infants (22%) with dopamine during the measurements. COx was higher in the dopamine group than the untreated group (0.41 ± 0.25 vs. 0.08 ± 0.25, p < 0.001). Blood pressure tended to be lower in the dopamine group, but the anticipated difference in cerebral oxygenation was not detected. The need for mechanical ventilation in the first day of life and incidences of mortality was higher in the dopamine group. CONCLUSION Dopamine therapy was associated with decreased CA in preterm infants. We were unable to determine whether dopamine directly impaired CA or was merely an indicator of illness.
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Affiliation(s)
- Vibeke R. Eriksen
- Department of Neonatology; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - Gitte H. Hahn
- Department of Neonatology; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Department of Paediatrics; Copenhagen University Hospital - Herlev Hospital; Herlev Denmark
| | - Gorm Greisen
- Department of Neonatology; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
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14
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Mehler K, Nowak M, Oberthuer A, Hahn M, Roth B, Kribs A. Blood sampling via a peripheral artery catheter decreases cerebral oxygenation index in very low-birthweight infants. Acta Paediatr 2014; 103:1227-32. [PMID: 25220877 DOI: 10.1111/apa.12805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/30/2014] [Accepted: 09/11/2014] [Indexed: 11/28/2022]
Abstract
AIM This study evaluated the impact of blood sampling via peripheral arterial catheters on cerebral oxygenation and blood volume as a function of blood sampling velocity. METHODS Near-infrared spectroscopy was applied to 20 very low-birthweight infants during peripheral arterial blood sampling. Changes in cerebral oxygenated, deoxygenated and total haemoglobin, cerebral blood volume and cerebral oxygenation index were recorded. Heart rate and oxygen saturation were measured continuously. To assess the impact of blood sampling velocity, both fast 40-sec and slow 70-sec sampling procedures were performed in a crossover study design, in which the order of sampling velocities was randomised for each patient. RESULTS Both fast and slow blood sampling procedures resulted in a significant decrease in cerebral oxygenation index (fast, p = 0.002, slow, p = 0.008), and an increase in mean heart rate (both p = 0.02) and mean blood pressure (p = 0.02 and 0.04). Oxygenated and total haemoglobin and cerebral blood volume only decreased significantly after slow blood sampling (p < 0.001). CONCLUSION Blood sampling from peripheral arterial catheters leads to significant fluctuations in cerebral oxygenation independent of the sampling velocity. Changes are comparable to those reported from umbilical blood sampling. We advise that blood sampling should be restricted as much as possible.
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Affiliation(s)
- Katrin Mehler
- Department of Neonatology; University of Cologne Children′s Hospital; Cologne Germany
| | - Mareike Nowak
- Department of Cardiology; Düren Community Hospital; Cologne Germany
| | - André Oberthuer
- Department of Neonatology; University of Cologne Children′s Hospital; Cologne Germany
| | - Moritz Hahn
- Institute of Medical Statistics, Informatics and Epidemiology; University of Cologne; Cologne Germany
| | - Bernhard Roth
- Department of Neonatology; University of Cologne Children′s Hospital; Cologne Germany
| | - Angela Kribs
- Department of Neonatology; University of Cologne Children′s Hospital; Cologne Germany
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15
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Pavlov AN, Semyachkina-Glushkovskaya OV, Zhang Y, Bibikova OA, Pavlova ON, Huang Q, Zhu D, Li P, Tuchin VV, Luo Q. Multiresolution analysis of pathological changes in cerebral venous dynamics in newborn mice with intracranial hemorrhage: adrenorelated vasorelaxation. Physiol Meas 2014; 35:1983-99. [PMID: 25238178 DOI: 10.1088/0967-3334/35/10/1983] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intracranial hemorrhage (ICH) is the major problem of modern neonatal intensive care. Abnormalities of cerebral venous blood flow (CVBF) can play a crucial role in the development of ICH in infants. The mechanisms underlying these pathological processes remain unclear; however it has been established that the activation of the adrenorelated vasorelaxation can be an important reason. Aiming to reach a better understanding of how the adrenodependent relaxation of cerebral veins contributes to the development of ICH in newborns, we study here the effects of pharmacological stimulation of adrenorelated dilation of the sagittal sinus by isoproterenol on the cerebral venous hemodynamics. Our study is performed in newborn mice at different stages of ICH using the laser speckle contrast imaging and wavelet analysis of the vascular dynamics of CVBF. We show that the dilation of the sagittal sinus with the decreased velocity of blood flow presides to the stress-induced ICH in newborn mice. These morphofunctional vascular changes are accompanied by an increased variance of the wavelet-coefficients in the areas of endothelial and non-endothelial (KATP-channels activity of vascular muscle) sympathetic components of the CVBF variability. Changes in the cerebral venous hemodynamics at the latent stage of ICH are associated with a high responsiveness of the sagittal sinus to isoproterenol quantifying by wavelet-coefficients related to a very slow region of the frequency domain. The obtained results certify that a high activation of the adrenergic-related vasodilatory responses to severe stress in newborn mice can be one of the important mechanisms underlying the development of ICH. Thus, the venous insufficiency with the decreased blood outflow from the brain associated with changes in the endothelial and the sympathetic components of CVBF-variability can be treated as prognostic criteria for the risk of ICH during the first days after birth.
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Affiliation(s)
- A N Pavlov
- Department of Physics, Saratov State University, Astrakhanskaya Str. 83, Saratov, 410012, Russia. Saratov State Technical University, Politehnicheskaya Str. 77, Saratov, 410054, Russia. Wuhan National Laboratory for Optoelectronics, Britton Chance Center for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
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Abstract
Ensuring adequate oxygenation of the developing brain is the cornerstone of neonatal critical care. Despite decades of clinical research dedicated to this issue of paramount importance, our knowledge and understanding regarding the physiology and pathophysiology of neonatal cerebral blood flow are still rudimentary. This review primarily focuses on currently available human clinical and experimental data on cerebral blood flow and autoregulation in the preterm and term infant. Limitations of systemic blood pressure values as surrogates for monitoring adequate cerebral oxygen delivery are discussed. Particular emphasis is placed on the high interindividual variability in cerebral blood flow values, vasoreactivity, and autoregulatory thresholds making the applications of normative values highly questionable. Technical and ethical difficulties to conduct such trials leave us with a near complete lack of knowledge on how pharmacological and surgical interventions impact on cerebral autoregulation. The ensemble of these works argues for the necessity of highly individualized care by taking advantage of continuous bedside monitoring of cerebral circulation. They also point to the urgent need for further studies addressing the exciting but difficult issue of cerebral blood flow autoregulation in the neonate.
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Affiliation(s)
- Laszlo Vutskits
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Geneva, Switzerland; Department of Fundamental Neuroscience, Geneva University Medical School, Geneva, Switzerland
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Affiliation(s)
- Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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