Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Electrical and Electronics Engineering, Shizuoka University, Hamamatsu, Japan.
Int J Med Sci. 2021 Mar 30;18(11):2262-2268. doi: 10.7150/ijms.53945. eCollection 2021.
Neonatal respiratory disorders, such as transient tachypnea of the newborn and respiratory distress syndrome, occur frequently after an elective cesarean delivery. Although conventional pulse oximetry is recommended for neonatal resuscitation, it often requires several minutes after birth to obtain a reliable signal. In a previous study, we used novel tissue oximetry equipment to detect fetal and neonatal early tissue oxygen saturation (StO) before and immediately after vaginal delivery. Therefore, we hypothesized that low neonatal StO levels measured by tissue oximetry may lead to neonatal respiratory disorder after a scheduled cesarean delivery. Hence, this study aimed to evaluate the StO levels measured by tissue oximetry in neonates with or without a respiratory disorder subsequently diagnosed after an elective cesarean delivery. We enrolled 78 pregnant Japanese women who underwent an elective cesarean section at ≥36 weeks' gestation. After combined spinal and epidural anesthesia were administered to the mother, fetal StO levels were measured by tissue oximetry using an examiner's finger-mounted sensor during a pelvic examination immediately before the cesarean section. We measured the neonatal StO levels at 1, 3, and 5 minutes after birth and retrospectively compared the fetal and neonatal StO levels with the incidence of subsequent diagnoses of neonatal respiratory disorders. The data of StO levels in 35 neonates were collected. Seven neonates (respiratory disorder (RD) group) were subsequently diagnosed with respiratory disorders by neonatal medicine specialists, whereas the 28 remaining neonates (NR group) were not. The median fetal StO (interquartile range) of the RD and NR groups was 52.0% (41.8%-60.8%) and 42.5% (39.0%-52.5%), respectively ( = 0.12). The median neonatal StO (interquartile range) of the RD and NR groups at 1 minute after birth was 42.0% (39.0%-44.0%) and 46.0% (42.0%-49.0%), respectively ( = 0.091). At 3 minutes after birth, the median neonatal StO (interquartile range) of the RD and NR groups was 41.0% (39.0%-46.0%) and 47.0% (44.3%-53.5%), respectively ( = 0.004). Finally, at 5 minutes after birth, the median neonatal StO (interquartile range) of the RD and NR groups was 45.0% (44.0%-52.0%) and 54.0% (49.3%-57.0%), respectively ( = 0.007). The StO values in the RD group were lower than those in the NR group at 3 and 5 minutes after birth, suggesting that neonates with low StO levels soon after birth may be predisposed to clinically diagnosed neonatal respiratory disorders.
新生儿呼吸障碍，如新生儿暂时性呼吸急促和呼吸窘迫综合征，在选择性剖宫产术后经常发生。虽然推荐常规脉搏血氧饱和度用于新生儿复苏，但通常需要在出生后几分钟才能获得可靠的信号。在之前的研究中，我们使用新型组织血氧饱和度仪在阴道分娩前和后立即检测胎儿和新生儿的早期组织氧饱和度 (StO)。因此，我们假设组织血氧饱和度仪测量的新生儿 StO 水平低可能导致选择性剖宫产术后新生儿呼吸障碍。因此，本研究旨在评估组织血氧饱和度仪测量的选择性剖宫产术后有或无呼吸障碍的新生儿的 StO 水平。 我们招募了 78 名接受选择性剖宫产术的日本孕妇，孕周≥36 周。在母亲接受脊髓-硬膜外联合麻醉后，在剖宫产前进行骨盆检查时，使用医生手指上的传感器通过组织血氧饱和度仪测量胎儿 StO 水平。我们在出生后 1、3 和 5 分钟测量新生儿 StO 水平，并回顾性比较胎儿和新生儿 StO 水平与随后诊断为新生儿呼吸障碍的发生率。 收集了 35 名新生儿的 StO 水平数据。7 名新生儿（呼吸障碍 (RD) 组）随后被新生儿医学专家诊断为呼吸障碍，而其余 28 名新生儿（NR 组）则没有。RD 组和 NR 组的中位数胎儿 StO（四分位距）分别为 52.0%（41.8%-60.8%）和 42.5%（39.0%-52.5%）（ = 0.12）。RD 组和 NR 组出生后 1 分钟的新生儿 StO（四分位距）中位数分别为 42.0%（39.0%-44.0%）和 46.0%（42.0%-49.0%）（ = 0.091）。出生后 3 分钟时，RD 组和 NR 组新生儿 StO（四分位距）中位数分别为 41.0%（39.0%-46.0%）和 47.0%（44.3%-53.5%）（ = 0.004）。最后，出生后 5 分钟时，RD 组和 NR 组新生儿 StO（四分位距）中位数分别为 45.0%（44.0%-52.0%）和 54.0%（49.3%-57.0%）（ = 0.007）。 出生后 3 分钟和 5 分钟时，RD 组的 StO 值低于 NR 组，这表明出生后不久 StO 值较低的新生儿可能更容易发生临床诊断的新生儿呼吸障碍。
