Journal article
Early brain and abdominal oxygenation in extremely low birth weight infants
Pediatric research, Vol.92(4), pp.1034-1041
10/2022
DOI: 10.1038/s41390-022-02082-z
PMCID: PMC9588487
PMID: 35513716
Abstract
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.
Details
- Title: Subtitle
- Early brain and abdominal oxygenation in extremely low birth weight infants
- Creators
- Valerie Y Chock - Lucile Packard Children's HospitalEmily Smith - RTI InternationalSylvia Tan - RTI InternationalM Bethany Ball - Lucile Packard Children's HospitalAbhik Das - RTI InternationalSusan R Hintz - Lucile Packard Children's HospitalHaresh Kirpalani - University of PennsylvaniaEdward F Bell - University of IowaLina F Chalak - The University of Texas Southwestern Medical CenterWaldemar A Carlo - University of Alabama at BirminghamC Michael Cotten - Duke UniversityJohn A Widness - University of IowaKathleen A Kennedy - The University of Texas Health Science CenterRobin K Ohls - University of New MexicoRuth B Seabrook - The Ohio State UniversityRavi M Patel - Children's Healthcare of AtlantaAbbot R Laptook - Women & Infants Hospital of Rhode IslandToni Mancini - University of PennsylvaniaGregory M Sokol - Indiana UniversityMichele C Walsh - Case Western Reserve UniversityBradley A Yoder - University of UtahBrenda B Poindexter - Children's Healthcare of AtlantaSanjay Chawla - Wayne State UniversityCarl T D'Angio - University of RochesterRosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentKrisa P Van Meurs - Lucile Packard Children's HospitalEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- Pediatric research, Vol.92(4), pp.1034-1041
- DOI
- 10.1038/s41390-022-02082-z
- PMID
- 35513716
- PMCID
- PMC9588487
- NLM abbreviation
- Pediatr Res
- ISSN
- 0031-3998
- eISSN
- 1530-0447
- Grant note
- UG1 HD068244 / NICHD NIH HHS UG1 HD053089 / NICHD NIH HHS UG1 HD027851 / NICHD NIH HHS UG1 HD040492 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS UG1 HD068284 / NICHD NIH HHS R01 HL122167 / NHLBI NIH HHS UG1 HD027880 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U01 HL112776 / NHLBI NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS UG1 HD068263 / NICHD NIH HHS UG1 HD021385 / NICHD NIH HHS UG1 HD087226 / NICHD NIH HHS UG1 HD068270 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS UG1 HD040689 / NICHD NIH HHS UL1 TR001117 / NCATS NIH HHS U01 HD036790 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS UG1 HD027856 / NICHD NIH HHS UG1 HD021364 / NICHD NIH HHS U01 HL112748 / NHLBI NIH HHS UG1 HD027853 / NICHD NIH HHS UG1 HD068278 / NICHD NIH HHS
- Language
- English
- Date published
- 10/2022
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984353943102771
Metrics
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