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How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Cerebral and somatic NIRS-determined oxygenation in IUGR preterm infants during transition
Valentina Bozzetti1, Giuseppe Paterlini1, Frank van Bel2
1a Neonatal Intensive Care Unit , MBBM Foundation, San Gerardo Hospital , Monza , Italy .
Insights
Near-infrared spectroscopy (NIRS) monitoring reveals that preterm infants with fetal growth restriction (IUGR) exhibit altered cerebral and splanchnic oxygenation, indicating a persistent brain-sparing effect post-birth.
Area of Science:
- Neonatal physiology
- Medical instrumentation
- Perinatal medicine
Background:
- Fetal growth restriction (IUGR) significantly impacts perinatal morbidity, particularly in preterm infants with impaired intestinal function.
- Near-infrared spectroscopy (NIRS) is a non-invasive tool for monitoring oxygenation in both the brain and intestines.
- Understanding oxygenation patterns in IUGR infants is crucial for managing their health outcomes.
Purpose of the Study:
- To investigate the cerebral and splanchnic oxygenation status in preterm infants with and without IUGR using NIRS.
- To compare the cerebral/splanchnic oxygenation ratio (CSOR) between IUGR and non-IUGR preterm infants during the early postnatal period.
Main Methods:
- A prospective case-control study involving 20 preterm infants (10 IUGR, 10 non-IUGR).
- Regional oximetry (rScO2 and rSsO2) was measured using NIRS in the first 24 hours of life (T0) and during the transitional period (T1).
- The cerebral/splanchnic oxygenation ratio (CSOR) was calculated.
Main Results:
- Both groups showed higher cerebral (rScO2) than splanchnic (rSsO2) oxygenation at T0 and T1.
- At T0, rScO2 did not differ, but rSsO2 was lower in IUGR infants.
- At T1, IUGR infants had lower rScO2 and higher rSsO2 compared to non-IUGR infants.
Conclusions:
- IUGR infants demonstrate a persistent brain-sparing effect with subsequent splanchnic reperfusion in the transitional period.
- NIRS can detect altered cerebral and splanchnic oxygenation patterns in preterm IUGR infants.
- These findings highlight unique vascular adaptations in IUGR infants adjusting to extra-uterine life.
Background:
Fetal growth restriction (intra-uterine growth restriction [IUGR]) has a considerable impact on perinatal morbidity. Preterm IUGR infants are prone to impaired intestine function. Near-infrared spectroscopy (NIRS) has been used to monitor oxygenation status of the brain and of the intestine.
Patients And Methods:
We conducted a prospective case-control study at our NICU in 20 preterm infants of whom 10 infants complicated by compared with 10 non-IUGR preterm infants. Splanchnic and cerebral regional oximetry values were measured with NIRS. Three hours of consecutive recordings were performed in the first 24 h of life, T0, and during the transitional period, T1. The cerebral/splanchnic oxygenation ratio, CSOR, (cerebral regional saturations [rScO2]/splanchnic regional saturations [rSsO2]) was also calculated.
Results:
Both in the IUGR and the non-IUGR infants, at T0 and T1 monitoring time-points, the rSO2 values were higher in the cerebral district when compared to those of the splanchnic area. Comparison of the NIRS parameters between the IUGR and non-IUGR infants at T0 showed no difference in rScO2, while rSsO2 was significantly lower in the IUGR group. At T1, rScO2 was significantly lower and rSsO2 higher in the IUGR group.
Conclusions:
Cerebral/splanchnic vascular adaptation of IUGR infants to the extra-uterine environment is characterized by a postnatal persistence of the brain sparing effect with reperfusion in the transitional period.
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