Kuik Sara J, van der Laan Michelle E, Brouwer-Bergsma Margot T, Hulscher Jan B F, Absalom Anthony R, Bos Arend F, Kooi Elisabeth M W
University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Division of Pediatric Anesthesiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Early Hum Dev. 2018 Mar;118:25-31. doi: 10.1016/j.earlhumdev.2018.01.019. Epub 2018 Feb 14.
Preterm infants requiring surgery are at risk of impaired neurocognitive development caused, possibly, by cerebral ischemia associated with impaired cerebrovascular autoregulation (CAR). We evaluated CAR before, during, and after laparotomy.
This was a hypothesis generating prospective observational cohort study.
We included preterm infants requiring surgery for necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). Before, during, and after surgery we measured cerebral oxygen saturation using NIRS and calculated cerebral fractional tissue oxygen extraction (cFTOE).
Impaired CAR was defined if correlation coefficients (rho) between mean cFTOE and mean arterial blood pressure values were ≤-0.30 with P < .05. We used logistic regression analyses to determine factors associated with impaired CAR.
Nineteen infants with median (IQR) GA 27.6 weeks (26.6-31.0), birth weight 1090 g (924-1430), and postnatal age 9 days (7-12) were included. CAR was impaired more often during surgery than before (12 versus 3, P = .02) or after (12 versus 0, P < .01). A higher PCO level was associated with impaired CAR during surgery (OR 3.04, 95% CI, 1.11-8.12 for every 1 kPa increase).
More than half of preterm infants with NEC or SIP displayed evidence of impaired CAR during laparotomy. Further research should focus on mechanisms contributing to impaired CAR in preterm infants during surgery.
需要手术的早产儿有神经认知发育受损的风险，这可能是由与脑血管自动调节（CAR）受损相关的脑缺血引起的。我们评估了剖腹手术前、手术期间和手术后的CAR。
这是一项产生假设的前瞻性观察队列研究。
我们纳入了因坏死性小肠结肠炎（NEC）或自发性肠穿孔（SIP）需要手术的早产儿。在手术前、手术期间和手术后，我们使用近红外光谱法测量脑氧饱和度，并计算脑分数组织氧摄取率（cFTOE）。
如果平均cFTOE与平均动脉血压值之间的相关系数（rho）≤-0.30且P<0.05，则定义为CAR受损。我们使用逻辑回归分析来确定与CAR受损相关的因素。
纳入了19例婴儿，中位（IQR）胎龄27.6周（26.6-31.0），出生体重1090g（924-1430），出生后年龄9天（7-12）。手术期间CAR受损的情况比手术前（12例对3例，P=0.02）或手术后（12例对0例，P<0.01）更常见。较高的PCO水平与手术期间CAR受损相关（每增加1kPa，OR为3.04，95%CI为1.11-8.12）。
超过一半的患有NEC或SIP的早产儿在剖腹手术期间表现出CAR受损的证据。进一步的研究应关注导致早产儿手术期间CAR受损的机制。
