Accounting for arterial and capillary blood gases for calculation of cerebral blood flow in preterm infants.

UNLABELLED

One of the most feared neurological complications of premature birth is intraventricular hemorrhage, frequently triggered by fluctuations in cerebral blood flow (CBF). Although several techniques for CBF measurement have been developed, they are not part of clinical routine in neonatal intensive care. A promising tool for monitoring of CBF is its numerical assessment using standard clinical parameters such as mean arterial pressure, carbon dioxide partial pressure (pCO) and oxygen partial pressure (pO). A standard blood gas analysis is performed on arterial blood. In neonates, capillary blood is widely used for analysis of blood gas parameters. The purpose of this study was the assessment of differences between arterial and capillary analysis of blood gases and adjustment of the mathematical model for CBF calculation to capillary values. The statistical analysis of pCO and pO values collected from 254 preterm infants with a gestational age of 23-30 weeks revealed no significant differences between arterial and capillary pCO and significantly lower values for capillary pO. The estimated mean differences between arterial and capillary pO of 15.15 mmHg (2.02 kPa) resulted in a significantly higher CBF calculated for capillary pO compared to CBF calculated for arterial pO. Two methods for correction of capillary pO were proposed and compared, one based on the mean difference and another one based on a regression model.

CONCLUSION

Capillary blood gas analysis with correction for pO as proposed in the present work is an acceptable alternative to arterial sampling for the assessment of CBF.

WHAT IS KNOWN

• Arterial blood analysis is the gold standard in clinical practice. However, capillary blood is widely used for estimating blood gas parameters. • There is no significant difference between the arterial and capillary pCO values, but the capillary pO differs significantly from the arterial one.

WHAT IS NEW

• The lower capillary pO values yield significantly higher values of calculated CBF compared to CBF computed from arterial pO measurements. • Two correction methods for the adjustment of capillary pO to arterial pO that made the difference in the calculated CBF insignificant have been proposed.