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The Effect of Continuous Positive Airway Pressure on Cerebral and Splanchnic Oxygenation in Preterm Infants
Jiayue Zhong1, Kei Lui2,3, Timothy Schindler2,3
1School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia, sophiezhong958@gmail.com.
Insights
Continuous positive airway pressure (CPAP) improved splanchnic oxygenation in preterm infants but did not alter cerebral oxygenation. CPAP enhances stable oxygen delivery to vital organs, crucial for infant respiratory support.
Area of Science:
- Neonatal physiology
- Respiratory support
- Tissue oxygenation
Background:
- Continuous positive airway pressure (CPAP) is vital for preterm infant breathing support.
- Limited research exists on CPAP's impact on regional oxygenation in neonates.
Purpose of the Study:
- To investigate the effects of CPAP on cerebral and splanchnic tissue oxygenation in preterm infants.
- To assess changes in oxygen saturation and variability with CPAP application.
Main Methods:
- Pilot observational study involving 26 preterm infants (25-37 weeks gestational age).
- Near-infrared spectroscopy used to measure regional cerebral and splanchnic oxygenation and variability (coefficient of variability).
- Measurements taken both with and without CPAP support.
Main Results:
- Mean cerebral oxygenation remained unchanged with CPAP, but variability decreased (CV 5% to 2%).
- Mean cerebral fractional oxygen extraction (FOE) increased with CPAP (0.13 to 0.17).
- Splanchnic oxygenation significantly increased (66% to 75%) and stabilized (CV 13% to 7%) with CPAP; splanchnic FOE decreased (0.28 to 0.22).
Conclusions:
- CPAP application did not affect mean cerebral oxygenation but significantly increased and stabilized splanchnic oxygenation in preterm infants.
- Findings underscore CPAP's role in maintaining stable oxygen delivery to vital organs in neonates.
- Respiratory support is critical for optimizing organ perfusion in vulnerable infants.
Background:
Despite the known clinical benefits of continuous positive airway pressure (CPAP) to support preterm infants breathing, there are limited studies that have examined its effect on regional oxygenation.
Objectives:
This study aimed to investigate how the application of CPAP affects cerebral and splanchnic tissue oxygenation in preterm infants.
Methods:
A pilot observational study was conducted in infants using near-infrared spectroscopy while off CPAP and on CPAP. Regional cerebral and splanchnic saturations and variability (coefficient of variability; CV) were evaluated.
Results:
Twenty-six infants (25-37 weeks gestational age at birth) were studied. The mean cerebral oxygenation did not differ with the application of CPAP (80 ± 4.2% without CPAP; 80 ± 1.9% with CPAP), but variability around the mean was less with CPAP (CV 5 vs. 2%, respectively). Mean cerebral fractional oxygen extraction (FOE) increased with CPAP from 0.13 ± 0.06 to 0.17 ± 0.04% (p = 0.002). Splanchnic oxygenation increased significantly from 66 ± 11.6 to 75 ± 9.1% with CPAP (p < 0.001) and also became more stable (CV 13 vs. 7%, respectively). Splanchnic FOE decreased with CPAP from 0.28 ± 0.13 to 0.22 ± 0.10% (p = 0.002).
Conclusion:
The application of CPAP did not affect mean cerebral oxygenation in this group of preterm and term infants; however, it led to a significant increase in splanchnic oxygenation. These findings highlight the important role that respiratory support may play in maintaining adequate and stable oxygen delivery to vital organs.
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