Cerbo Rosa Maria, Scudeller Luigia, Maragliano Roberta, Cabano Rita, Pozzi Margherita, Tinelli Carmine, Bollani Lina, Stronati Mauro
Neonatal Intensive Care Unit, Scientific Direction, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Neonatology. 2015;108(4):246-52. doi: 10.1159/000438452. Epub 2015 Aug 25.
Brain vulnerability in the critically ill preterm newborn may be related to the burden of cerebral hypoxygenation and hypoperfusion during the immediate postnatal period.
We determined the association between adverse outcomes [death or high grade intraventricular hemorrhage (IVH)] and continuous cerebral tissue oxygen saturation (rSO2), superior vena cava flow (SVCf) and cerebral fractional oxygen extraction (CFOE) in very low birth weight (VLBW) infants during the first 48 h of life.
We studied a prospective cohort of 60 VLBW infants admitted to our neonatal intensive care unit within the first 6 h of life between March 2010 and June 2012. rSO2 (expressed as a number of summary measures) was continuously monitored with near-infrared spectroscopy (INVOS 5100 Somanetic) during the first 48 h of life, SCVf was measured at 4-6, 12, 24 and 48 h after birth, and CFOE was calculated.
The mean gestational age was 27.9 (SD 2.39); 8 infants died (13.3%) and 7 developed IVH grade III-IV: 1 in the alive group and 6 in the deceased group (p < 0.001). The odds ratio for death was 1.08 (95% CI: 1.015-1.15, p = 0.016) for each 10 periods of rSO2 values <40% in the first 48 h, and 4.2 (95% CI: 1.27-14.05, p = 0.019) for SVCf values <40 ml/kg/min. Among alive babies, mean CFOE decreased at 24, 36 and 48 h; among deceased babies it did not (p < 0.001). In the multivariate analyses, these results retained significance.
Both rSO2 ≤40% and SVCf <40 ml/kg/min independently increase the risk of death. The trend in CFOE supports the ischemic-hypoperfusion hypothesis as a mechanism for cerebral damage.
危重新生早产儿的脑易损性可能与出生后即刻的脑缺氧和低灌注负担有关。
我们确定了极低出生体重（VLBW）婴儿出生后48小时内不良结局[死亡或重度脑室内出血（IVH）]与连续脑组织氧饱和度（rSO2）、上腔静脉血流（SVCf）和脑氧摄取分数（CFOE）之间的关联。
我们研究了2010年3月至2012年6月期间在出生后6小时内入住我们新生儿重症监护病房的60例VLBW婴儿的前瞻性队列。在出生后48小时内，用近红外光谱仪（INVOS 5100 Somanetic）连续监测rSO2（以多个汇总指标表示），在出生后4、6、12、24和48小时测量SVCf，并计算CFOE。
平均胎龄为27.9（标准差2.39）；8例婴儿死亡（13.3%），7例发生III-IV级IVH：存活组1例，死亡组6例（p<0.001）。出生后48小时内，每10个rSO2值<40%的时间段，死亡的比值比为1.08（95%可信区间：1.015-1.15，p=0.016），SVCf值<40 ml/kg/min时为4.2（95%可信区间：1.27-14.05，p=0.019）。在存活婴儿中，平均CFOE在24、36和48小时下降；在死亡婴儿中则没有（p<0.001）。在多变量分析中，这些结果仍具有显著性。
rSO2≤40%和SVCf<40 ml/kg/min均独立增加死亡风险。CFOE的趋势支持缺血-低灌注假说是脑损伤的一种机制。
