Changes of cerebral hemodynamics and oxygenation in unstable septic newborns during exchange transfusion

We investigated the effect of a two-way exchange transfusion on cerebral hemodynamics and oxygenation in 3 neonates using near infrared spectroscopy (NIRS). A total of 4 exchange transfusions (ET) for the treatment of sepsis were performed. Cerebral oxyhemoglobin concentrations (HbO2) increased immediately after commencing with ET by 8.82 +/- 3.46 (mean +/- SD) micromol/l, which persisted throughout the ET. Total hemoglobin concentrations (HbT) simultaneously increased by 8.92 +/- 3.81 (mean +/- SD) micromol/l. No changes in cerebral deoxyhemoglobin concentrations (HbR) and cytochrome aa3 (Cytaa3) were observed. In one occasion, however, HbR increased markedly and HbO2 decreased immediately after ET had begun, thus HbT remained slightly increased compared to the 3 other occasions. The extension of periventricular echogenecity was observed after ET by cranial ultrasound scan in this patient and periventricular leukomalacia was confirmed by autopsy. We conclude that a two-way exchange transfusion increases cerebral blood volume and improves cerebral oxygen delivery. Furthermore NIRS was useful in monitoring changes in cerebral hemodynamics and oxygenation in unstable septic neonates.