Underwood Mark A, Milstein Jay M, Sherman Michael P
Division of Neonatology, Department of Pediatrics, Davis School of Medicine, University of California, Davis, CA 95616, USA.
Neonatology. 2007;91(2):134-9. doi: 10.1159/000097131. Epub 2006 Nov 20.
Patent ductus arteriosus (PDA) is frequent and potentially pathologic in preterm infants. A simple bedside tool to screen for ductal patency would assist in the care of extremely low birth weight (ELBW) infants.
To investigate the utility of near-infrared spectroscopy (NIRS) in identifying ELBW infants who would benefit from early echocardiography.
Tissue oxygen saturation (S(t)O(2)) was measured by NIRS in the lungs, brain, skeletal muscle and kidney of 20 ELBW infants. Comparisons were made between the S(t)O(2) in these organs and the need for intervention for a PDA. All studies were performed within the first 4 days of life. Similar measurements were performed following treatment with indomethacin in nine of the patients.
The S(t)O(2) of skeletal muscle (left deltoid) and kidney differed between the infants who were treated for PDA and those who were not (p = 0.01 for both). As a screen for a PDA requiring intervention, deltoid S(t)O(2) had sensitivity 77% and specificity 83%, and kidney S(t)O(2) had sensitivity 85% and specificity 83%. Following treatment with indomethacin, the low S(t)O(2) in the deltoid and kidney increased toward the range seen in patients who did not require treatment of a PDA. Inter- and intra-observer variability ranged from minimal to high.
This pilot study of a portable NIRS device shows encouraging efficacy in identifying ELBW infants who were likely to benefit from early echocardiography and subsequent intervention to close a PDA. Further study is warranted.
动脉导管未闭（PDA）在早产儿中很常见且可能具有病理性。一种简单的床旁工具来筛查导管通畅情况将有助于极低出生体重（ELBW）婴儿的护理。
研究近红外光谱（NIRS）在识别能从早期超声心动图检查中获益的ELBW婴儿中的作用。
对20例ELBW婴儿的肺、脑、骨骼肌和肾脏进行NIRS测量组织氧饱和度（S(t)O(2)）。比较这些器官中的S(t)O(2)与PDA干预需求情况。所有研究均在出生后4天内进行。9例患者在使用吲哚美辛治疗后进行了类似测量。
接受PDA治疗的婴儿与未接受治疗的婴儿相比，骨骼肌（左三角肌）和肾脏的S(t)O(2)存在差异（两者p均 = 0.01）。作为需要干预的PDA的筛查指标，三角肌S(t)O(2)的敏感性为77%，特异性为83%，肾脏S(t)O(2)的敏感性为85%，特异性为83%。使用吲哚美辛治疗后，三角肌和肾脏中较低的S(t)O(2)向无需治疗PDA的患者所见范围升高。观察者间和观察者内的变异性从最小到最大不等。
这项关于便携式NIRS设备的初步研究显示，在识别可能从早期超声心动图检查及随后关闭PDA的干预中获益的ELBW婴儿方面，具有令人鼓舞的效果。有必要进行进一步研究。
