Baik-Schneditz Nariae, Schwaberger Bernhard, Mileder Lukas, Höller Nina, Avian Alexander, Urlesberger Berndt, Pichler Gerhard
Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria.
Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, 8036 Graz, Austria.
Children (Basel). 2021 May 24;8(6):439. doi: 10.3390/children8060439.
The immediate transition from foetus to neonate includes substantial changes, especially concerning the cardiovascular system. Furthermore, the brain is one of the most vulnerable organs to hypoxia during this period. According to current guidelines for postnatal stabilization, the recommended parameters for monitoring are heart rate (HR) and arterial oxygen saturation (SpO). Recently, there is a growing interest in advanced monitoring of the cardio-circulatory system and the brain to get further objective information about the neonate's condition during the immediate postnatal transition after birth. The aim of the present study was to combine cardiac output (CO) and brain oxygenation monitoring in term neonates after caesarean section in order to analyse the potential influence of CO on cerebral oxygenation during neonatal transition. This was a monocentric, prospective, observational study. For non-invasive cardiac output measurements, the electrical velocimetry (EV) method (Aesculon Monitor, Osypka Medical, CA, USA) was used. The pulse oximeter probe for SpO and HR measurements was placed on the right hand or wrist. The cerebral tissue oxygen index (cTOI) was measured using a NIRO-200NX monitor with the near-infrared spectroscopy (NIRS) transducer on the right frontoparietal head. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, mean CO was calculated from six 10 s periods (with beat-to-beat analysis). During the study period, 99 term neonates were enrolled. Data from neonates with uncomplicated transitions were analysed. CO showed a tendency to decrease until minute 10. During the complete observational period, there was no significant correlation between CO and cTOI. The present study was the first to investigate a possible correlation between CO and cerebral oxygenation in term infants during the immediate neonatal transition. In term infants with uncomplicated neonatal transition after caesarean section, CO did not correlate with cerebral oxygenation.
从胎儿到新生儿的即刻转变包含诸多重大变化，尤其是在心血管系统方面。此外，在此期间，大脑是对缺氧最为敏感的器官之一。根据当前的产后稳定指南，推荐的监测参数是心率（HR）和动脉血氧饱和度（SpO）。近来，人们越来越关注对心血管系统和大脑进行高级监测，以便在出生后的即刻转变期间获取有关新生儿状况的更多客观信息。本研究的目的是在剖宫产术后的足月儿中联合监测心输出量（CO）和脑氧合，以分析CO在新生儿转变过程中对脑氧合的潜在影响。这是一项单中心、前瞻性、观察性研究。对于无创心输出量测量，使用了电测速法（EV）（美国加利福尼亚州奥西普卡医疗公司的Aesculon Monitor）。用于测量SpO和HR的脉搏血氧饱和度探头置于右手或手腕上。使用带有近红外光谱（NIRS）传感器的NIRO - 200NX监测仪在右额顶头部测量脑组织氧合指数（cTOI）。监测从出生后第1分钟开始，持续至出生后第15分钟。在出生后第5、10和15分钟，从六个10秒时间段（逐搏分析）计算平均CO。在研究期间，纳入了99名足月儿。分析了转变过程无并发症的新生儿的数据。CO在第10分钟前呈下降趋势。在整个观察期内，CO与cTOI之间无显著相关性。本研究首次探讨了足月儿在新生儿即刻转变期间CO与脑氧合之间可能存在的相关性。在剖宫产术后新生儿转变过程无并发症的足月儿中，CO与脑氧合不相关。
