Beck Jonathan, Loron Gauthier, Masson Claire, Poli-Merol Marie-Laurence, Guyot Eliane, Guillot Camille, Bednarek Nathalie, François Caroline
Neonatal and Pediatric Intensive Care Unit, CHU of Reims American Memorial Hospital, Reims, France.
Department of Research and Public Health, CHU of Reims, Reims, France.
Front Pediatr. 2017 Jun 14;5:140. doi: 10.3389/fped.2017.00140. eCollection 2017.
Depending on the initial pathology, hypovolemia, intra-abdominal hypertension, and sepsis are often encountered in neonatal digestive surgery. Accurate newborn monitoring during and after surgery is essential to adapt resuscitation protocols. Near infrared spectroscopy (NIRS) is non-invasive and can detect hypoperfusion which indicates a low circulatory blood flow, regardless of the cause.
Evaluating changes in cerebral and renal regional oxygen saturation during neonatal digestive surgeries, conducted according to normal practices, with commonly used monitoring parameters. Analyzing retrospectively the inter-relationships between NIRS values and mean arterial pressure (MAP) values as well as pre-ductal SpO.
Prospective, descriptive, monocentric study. All neonates referred for surgery were included. NIRS allows the measurement of cerebral and renal oxygenation fluctuations, as well as calculating difference in intraoperative and postoperative values.
Nineteen patients were included. Cerebral regional oxygen saturation (C rSO) values were stable while renal regional oxygen saturation (R rSO) values tended to decrease with time during surgery. Indeed, 72% of rSO decline episodes occurred after the first 30 min of surgery, without any significant statistical differences for the next 90 min of surgery. After surgery, the lowest average C and R rSO values were evidenced during the first 6 h, with 60% of C rSO and R rSO anomalies occurring in that time frame. There was no significant statistical difference observed in the following 18 h. There was a significant correlation between R rSO and SpO values ( < 0.01), but not with C rSO values. There was no correlation with the MAP either for the C rSO values or R rSO ones.
NIRS is a promising non-invasive bedside tool to monitor cerebral and tissue perfusion, analyzing tissue microcirculation. NIRS has its interest to guide neonatal digestive surgeries (bowel manipulation, viscera reduction) and may represent an early warning for identifying patients requiring resuscitation during or after these surgeries.
根据初始病理情况，新生儿消化外科手术中常出现低血容量、腹腔内高压和脓毒症。手术期间及术后准确的新生儿监测对于调整复苏方案至关重要。近红外光谱（NIRS）是非侵入性的，能够检测到表明循环血流量低的低灌注情况，而不论其原因如何。
评估按照常规做法进行的新生儿消化外科手术期间，常用监测参数下脑和肾局部氧饱和度的变化。回顾性分析NIRS值与平均动脉压（MAP）值以及导管前血氧饱和度（SpO）之间的相互关系。
前瞻性、描述性、单中心研究。纳入所有接受手术治疗的新生儿。NIRS可测量脑和肾的氧合波动情况，并计算术中和术后的值的差异。
纳入19例患者。手术期间脑局部氧饱和度（CrSO）值稳定，而肾局部氧饱和度（RrSO）值随时间有下降趋势。实际上，72%的rSO下降事件发生在手术开始后的前30分钟，在接下来的90分钟手术中无显著统计学差异。术后，最低平均CrSO和RrSO值出现在最初6小时内，60%的CrSO和RrSO异常发生在该时间段内。在接下来的18小时内未观察到显著统计学差异。RrSO与SpO值之间存在显著相关性（<0.01），但与CrSO值无关。CrSO值和RrSO值与MAP均无相关性。
NIRS是一种有前景的非侵入性床边工具，可用于监测脑和组织灌注，分析组织微循环。NIRS对于指导新生儿消化外科手术（肠道操作、脏器复位）具有重要意义，可能是识别这些手术期间或术后需要复苏的患者的早期预警指标。
