El-Dib Mohamed, Soul Janet S
Neonatal Neurocritical Care, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Fetal-Neonatal Neurology Program, Department of Neurology, Boston Children's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States.
Handb Clin Neurol. 2019;162:295-314. doi: 10.1016/B978-0-444-64029-1.00014-X.
While cardiorespiratory monitoring is standard for newborns in the NICU, monitoring of brain hemodynamics and oxygenation is usually sporadic and targeted to newborns with suspected or confirmed neurologic disorders. This is unfortunate, since critically ill newborns, both preterm and term-born, are at high risk of brain injury and would benefit from improved techniques for continuous monitoring of brain hemodynamics and oxygenation, in addition to monitoring of systemic hemodynamics and oxygenation. Near-infrared spectroscopy (NIRS) and, to a lesser extent, Doppler ultrasound are techniques that have been used in research and increasingly for clinical purposes to measure and monitor brain hemodynamics and oxygenation in newborns. NIRS monitoring can be useful for detection of diverse pathologic conditions that occur frequently in very preterm newborns and in selected populations of term newborns at risk for brain injury related to disturbances of systemic hemodynamics. This chapter reviews the current state of the art with regard to brain-monitoring techniques and the research directed at this important area, and it concludes with suggestions for the use of currently available tools to manage newborns at high risk of neurologic injury from disturbances in brain hemodynamics and oxygenation.
虽然心肺监测是新生儿重症监护病房（NICU）中新生儿的标准监测项目，但脑血流动力学和氧合监测通常是零星的，且针对疑似或确诊患有神经系统疾病的新生儿。这很遗憾，因为无论是早产儿还是足月儿，危重新生儿都有很高的脑损伤风险，除了监测全身血流动力学和氧合外，若能改进持续监测脑血流动力学和氧合的技术，他们将从中受益。近红外光谱（NIRS）以及在较小程度上的多普勒超声，是已用于研究且越来越多地用于临床目的的技术，用于测量和监测新生儿的脑血流动力学和氧合。NIRS监测对于检测极早产儿以及某些有因全身血流动力学紊乱而导致脑损伤风险的足月儿群体中频繁出现的各种病理状况可能有用。本章回顾了脑监测技术的当前技术水平以及针对这一重要领域的研究，并以关于使用现有工具来管理因脑血流动力学和氧合紊乱而有神经损伤高风险的新生儿的建议作为结尾。
