Early brain and abdominal oxygenation in extremely low birth weight infants.

Pregnancy Female Infant, Newborn Humans Infant, Premature Infant, Extremely Low Birth Weight Birth Weight Prospective Studies Oxygen Brain Hemoglobins Cerebrovascular Circulation

Journal

Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714

Informations de publication

Date de publication:
10 2022
Historique:
received: 24 09 2021
accepted: 10 04 2022
revised: 24 02 2022
pubmed: 6 5 2022
medline: 26 10 2022
entrez: 5 5 2022
Statut: ppublish

Résumé

Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined. A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables. In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001). Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population. Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies. Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases. A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome. Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.

Sections du résumé

BACKGROUND
Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined.
METHODS
A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables.
RESULTS
In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001).
CONCLUSION
Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population.
IMPACT
Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies. Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases. A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome. Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.

Identifiants

DOI: 10.1038/s41390-022-02082-z PMID: 35513716 PMC: PMC9588487
pubmed: 35513716
doi: 10.1038/s41390-022-02082-z
pii: 10.1038/s41390-022-02082-z
pmc: PMC9588487
mid: NIHMS1799946
doi:

Substances chimiques

Oxygen S88TT14065
Hemoglobins 0

Types de publication

Multicenter Study Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

1034-1041

Subventions

Organisme : NICHD NIH HHS
ID : UG1 HD068263
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD021373
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD087226
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD053089
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD027856
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD034216
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD027904
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD027880
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001117
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD053109
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD027851
Pays : United States
Organisme : NICHD NIH HHS
ID : U10 HD036790
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD068278
Pays : United States
Organisme : NICHD NIH HHS
ID : U01 HD036790
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL112776
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL122167
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD068270
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD068244
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD027853
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD087229
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL112748
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD040689
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD068284
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD021385
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD040492
Pays : United States
Organisme : NICHD NIH HHS
ID : UG1 HD021364
Pays : United States

Informations de copyright

© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

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Auteurs

Valerie Y Chock (VY)

Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA. vchock@stanford.edu.

Emily Smith (E)

Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, Rockville, NC, USA.

Sylvia Tan (S)

Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, Rockville, NC, USA.

M Bethany Ball (MB)

Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.

Abhik Das (A)

Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA.

Susan R Hintz (SR)

Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.

Haresh Kirpalani (H)

Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.

Edward F Bell (EF)

Department of Pediatrics, University of Iowa, Iowa City, IA, USA.

Lina F Chalak (LF)

Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Waldemar A Carlo (WA)

Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA.

C Michael Cotten (CM)

Department of Pediatrics, Duke University, Durham, NC, USA.

John A Widness (JA)

Department of Pediatrics, University of Iowa, Iowa City, IA, USA.

Kathleen A Kennedy (KA)

Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.

Robin K Ohls (RK)

University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.

Ruth B Seabrook (RB)

Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

Ravi M Patel (RM)

Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA.

Abbot R Laptook (AR)

Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA.

Toni Mancini (T)

Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.

Gregory M Sokol (GM)

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

Michele C Walsh (MC)

Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.

Bradley A Yoder (BA)

Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.

Brenda B Poindexter (BB)

Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA.

Sanjay Chawla (S)

Department of Pediatrics, Wayne State University, Detroit, MI, USA.

Carl T D'Angio (CT)

University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.

Rosemary D Higgins (RD)

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
College of Health and Human Services, George Mason University, Fairfax, VA, USA.

Krisa P Van Meurs (KP)

Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.

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Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Prématuré › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Nourrisson à faible poids de naissance › Nourrisson très faible poids naissance › Nourrisson de poids extrêmement faible à la naissance › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Phénomènes physiologiques › Croissance et développement › Croissance › Mensurations corporelles › Poids › Poids de naissance › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Produits chimiques inorganiques › Gaz › Oxygène › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Système nerveux › Système nerveux central › Encéphale › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Hémoprotéines › Globines › Hémoglobines › Early brain and abdominal oxygenation in...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Circulation sanguine › Circulation cérébrovasculaire › Early brain and abdominal oxygenation in...