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Preterm infants undergoing laparotomy for necrotizing enterocolitis or spontaneous intestinal perforation display

Sara J Kuik1, Michelle E van der Laan1, Margot T Brouwer-Bergsma2

  • 1University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.

Early Human Development
|February 18, 2018
PubMed

Insights

Cerebrovascular autoregulation (CAR) is frequently impaired in preterm infants undergoing surgery for necrotizing enterocolitis or intestinal perforation. Impaired CAR during surgery may be linked to elevated PCO2 levels.

Area of Science:

  • Neonatal surgery
  • Pediatric neurocritical care
  • Cerebrovascular physiology

Background:

  • Preterm infants undergoing surgery face risks of neurocognitive deficits.
  • Cerebral ischemia and impaired cerebrovascular autoregulation (CAR) are potential causes.
  • This study investigated CAR in preterm infants during laparotomy.

Purpose of the Study:

  • To evaluate cerebrovascular autoregulation (CAR) in preterm infants before, during, and after laparotomy.
  • To identify factors associated with impaired CAR in this vulnerable population.

Main Methods:

  • Prospective observational cohort study including preterm infants undergoing surgery for necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP).
  • Cerebral oxygen saturation and cerebral fractional tissue oxygen extraction (cFTOE) were measured using NIRS.
  • Impaired CAR was defined by the correlation between cFTOE and mean arterial blood pressure.

Main Results:

  • Nineteen preterm infants were included (median GA 27.6 weeks).
  • Impaired CAR was significantly more common during surgery (12/19) compared to before (3/19) or after (0/19).
  • Elevated PCO2 levels were associated with impaired CAR during surgery (OR 3.04).

Conclusions:

  • Over half of preterm infants with NEC or SIP showed impaired CAR during laparotomy.
  • Impaired CAR during surgery highlights a critical window for potential brain injury.
  • Further research is needed to understand the mechanisms of impaired CAR in surgical preterm infants.
Abstract

Keywords:
Cerebrovascular autoregulationLaparotomyNear-infrared spectroscopyNecrotizing enterocolitisPreterm infants

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