Altit Gabriel, Bhombal Shazia, Tacy Theresa A, Chock Valerie Y
Division of Neonatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada.
Division of Neonatal and Developmental Medicine, Stanford University - Lucile Packard Children's Hospital, Palo Alto, California, USA.
Neonatology. 2018;114(1):53-61. doi: 10.1159/000487472. Epub 2018 Apr 12.
For neonates with congenital heart disease (CHD), left-sided (LL) and right-sided (RL) single ventricular physiologies (LL, hypoplastic left heart syndrome; RL, tricuspid atresia or pulmonary atresia with intact ventricular septum) may demonstrate distinct changes in tissue saturation in the first 72 h of life. Near-infrared spectroscopy (NIRS) can measure regional cerebral saturation (Csat) and renal saturation (Rsat) to clarify differences between LL and RL over time.
Our primary objective was to measure changes in Csat and Rsat in the first 72 h of life using NIRS between CHD infants with LL compared to RL. The secondary objective was to correlate NIRS values to an echocardiographic marker of perfusion.
Newborns with hypoplastic left heart syndrome, tricuspid atresia, and pulmonary atresia with intact ventricular septum from 2013 to 2016 underwent routine NIRS monitoring. Csat, Rsat, and systemic saturations (SpO2) in the first 72 h of life were retrospectively analyzed and the echocardiographic descending aorta velocity time integral (VTI) was measured. Mixed effects models compared differences over time between LL and RL.
The final cohort included 13 LL, 12 RL, and 4 controls. Csat decreased for RL compared to LL (p = 0.005), while Rsat decreased for both (p = 0.008). Over time, SpO2 increased for LL but decreased for RL (p = 0.046). Compared to the controls, infants with CHD had lower Csat, lower Rsat, and lower SpO2. The descending aorta VTI was correlated with Rsat (R2 = 0.24, p = 0.02).
NIRS Csat measures were better preserved in LL compared to RL. Rsat decreased in both groups through time. The correlation between the descending aorta VTI and Rsat suggests an association between NIRS measures of renal saturation and renal perfusion.
对于患有先天性心脏病（CHD）的新生儿，左侧（LL）和右侧（RL）单心室生理状态（LL，左心发育不全综合征；RL，三尖瓣闭锁或室间隔完整的肺动脉闭锁）在出生后72小时内可能表现出组织饱和度的明显变化。近红外光谱（NIRS）可以测量局部脑饱和度（Csat）和肾饱和度（Rsat），以阐明LL和RL随时间的差异。
我们的主要目的是使用NIRS测量LL与RL的CHD婴儿出生后72小时内Csat和Rsat的变化。次要目的是将NIRS值与灌注的超声心动图标记物相关联。
对2013年至2016年患有左心发育不全综合征、三尖瓣闭锁和室间隔完整的肺动脉闭锁的新生儿进行常规NIRS监测。回顾性分析出生后72小时内的Csat、Rsat和全身饱和度（SpO2），并测量超声心动图降主动脉速度时间积分（VTI）。混合效应模型比较了LL和RL随时间的差异。
最终队列包括13例LL、12例RL和4例对照。与LL相比，RL的Csat降低（p = 0.005），而两者的Rsat均降低（p = 0.008）。随着时间的推移，LL的SpO2升高而RL的SpO2降低（p = 0.046）。与对照组相比，患有CHD的婴儿Csat、Rsat和SpO2较低。降主动脉VTI与Rsat相关（R2 = 0.24，p = 0.02）。
与RL相比，LL的NIRS Csat测量值保存得更好。两组的Rsat均随时间下降。降主动脉VTI与Rsat之间的相关性表明肾饱和度的NIRS测量值与肾灌注之间存在关联。
