Division of Neonatology, Stanford University School of Medicine, Stanford, CA.
Division of Neonatology, Yale School of Medicine, New Haven, CT.
J Pediatr. 2020 Dec;227:94-100.e1. doi: 10.1016/j.jpeds.2020.08.036. Epub 2020 Aug 17.
To determine if decreased cerebral oxygenation or altered cerebral autoregulation as measured by near-infrared spectroscopy (NIRS) in the first 96 postnatal hours is associated with an increased risk of death or severe neuroradiographic abnormalities in very preterm infants.
The Early NIRS prospective, multicenter study enrolled very preterm infants with a birth weight of <1250 g from 6 tertiary neonatal intensive care units. Mean arterial blood pressure and cerebral oxygen saturation (Csat) were continuously monitored using a neonatal sensor until 96 hours of age. Moving window correlations between Csat and mean arterial blood pressure determined time periods with altered cerebral autoregulation, and percentiles of correlation were compared between infants with and without the adverse outcome of mortality or severe neuroradiographic abnormalities by early cranial ultrasound.
Of 103 subjects with mean gestational age of 26 weeks, 21 (20%) died or had severe neuroradiographic abnormalities. Infants with adverse outcomes had a lower mean Csat (67 ± 9%) compared with those without adverse outcomes (72 ± 7%; P = .02). A Csat of <50% was identified as a cut-point for identifying infants with adverse outcome (area under the curve, 0.76). Infants with adverse outcomes were more likely to have significant positive or negative correlations between Csat and mean arterial blood pressure, indicating impaired cerebral autoregulation (P = .006).
Early NIRS monitoring may detect periods of lower cerebral oxygenation and altered cerebral autoregulation, identifying preterm infants at risk for mortality or neuroradiographic injury. An improved understanding of the relationship between altered hemodynamics and cerebral oxygenation may inform future strategies to prevent brain injury.
通过近红外光谱（NIRS）测量，在出生后 96 小时内，确定脑氧合减少或脑自动调节改变与极早产儿死亡或严重神经影像学异常的风险增加是否相关。
早期 NIRS 前瞻性、多中心研究纳入了来自 6 个三级新生儿重症监护病房的出生体重<1250g 的极早产儿。使用新生儿传感器连续监测平均动脉血压和脑氧饱和度（Csat），直至 96 小时。Csat 和平均动脉血压之间的移动窗口相关性确定了脑自动调节改变的时间段，并通过早期头颅超声比较了死亡率或严重神经影像学异常不良结局婴儿与无不良结局婴儿的相关百分位数。
在 103 名平均胎龄为 26 周的受试者中，21 名（20%）死亡或有严重神经影像学异常。不良结局婴儿的平均 Csat（67±9%）低于无不良结局婴儿（72±7%；P=0.02）。Csat<50%被确定为识别不良结局婴儿的临界点（曲线下面积，0.76）。有不良结局的婴儿更可能出现 Csat 和平均动脉血压之间显著的正相关或负相关，表明脑自动调节受损（P=0.006）。
早期 NIRS 监测可能会检测到脑氧合减少和脑自动调节改变的时期，识别出有死亡或神经影像学损伤风险的早产儿。对血流动力学改变和脑氧合之间关系的深入了解可能为预防脑损伤的未来策略提供信息。
