Department of Pediatrics, Command Hospital and Armed Forces Medical College, Pune, India.
Department of Pediatrics, Command Hospital, Lucknow, India.
Curr Pediatr Rev. 2022;18(4):301-317. doi: 10.2174/1573396318666220304210653.
Near-infrared spectroscopy (NIRS) has been used for monitoring cerebral oxygen saturation (rSO2) in neonates. There is a lack of data from low-middle income countries (LMIC) setting of cerebral rSO2 in neonates with encephalopathy of diverse etiologies. This study aimed to monitor cerebral rSO2 using NIRS in encephalopathic neonates to maintain the rSO2 between 55 to 85 % in the first 72 hours of admission to improve short-term neurodevelopmental outcomes (NDO).
This prospective cohort study enrolled encephalopathic neonates with hypoxic- ischemic encephalopathy (HIE) and non-HIE etiologies into 8 clinical categories. The cerebral rSO2 was monitored and targeted to be between 55 to 85 %, with predefined actions and management alterations over 72 hours. The neurodevelopmental assessment was conducted at 3, 6, and 9-12 months corrected age. Moreover, the motor and mental developmental quotients (MoDQ) (MeDQ) were recorded and compared to historical control.
A total of 120 neonates were enrolled and assessed for NDO. The MoDQ (mean ± SD) was 92.55 ± 14.85, 93.80 ± 13.20, 91.02 ± 12.69 and MeDQ (mean ± SD) was 91.80 ± 12.98, 91.80 ± 13.69, 88.41 ± 11.60 at 3, 6 and 9-12 months. The MoDQ and MeDQ scores of the historic cohort at 12 months were 86.35 ± 20.34 and 86.58 ± 18.27. The mean difference [MD (95 %CI)] for MoDQ was - 4.670 (- 8.48 to - 0.85) (p=0.0165) and for MeDQ was - 1.83 (- 5.26 to 1.6) (p=0.29). There was a negative correlation between the composite developmental quotient (CoDQ) with mean rSO2 and a positive correlation with cerebral fractional tissue oxygen extraction (CFTOE). Neonates with HIE and neonatal encephalopathy (NE) (n=37/120) had the lowest motor and mental DQ on neurodevelopmental assessment. Clinical categories, neonatal meningitis (NM), and intraventricular hemorrhage (IVH) improved in DQ scores over the study period.
Monitoring and maintaining cerebral rSO2 between 55-85 % through appropriate management changes improved neurodevelopmental scores at the 12-month follow-up in neonates with encephalopathy caused by varied etiologies.
近红外光谱（NIRS）已被用于监测新生儿的脑氧饱和度（rSO2）。在病因各异的脑病新生儿中，来自中低收入国家（LMIC）的大脑 rSO2 数据仍然缺乏。本研究旨在通过 NIRS 监测脑病新生儿的大脑 rSO2，以在入院后 72 小时内将 rSO2 维持在 55-85%，以改善短期神经发育结局（NDO）。
这项前瞻性队列研究将伴有缺氧缺血性脑病（HIE）和非 HIE 病因的脑病新生儿纳入 8 个临床类别。监测大脑 rSO2，并将其目标设定在 55-85%之间，在 72 小时内通过预设的治疗方案和管理调整来实现。在 3、6 和 9-12 个月的矫正年龄时进行神经发育评估。此外，记录并比较运动和智力发育商（MoDQ）（MeDQ）。
共有 120 名新生儿入组并进行了 NDO 评估。MoDQ（平均值±标准差）分别为 3 个月时 92.55±14.85、6 个月时 93.80±13.20、9-12 个月时 91.02±12.69，MeDQ（平均值±标准差）分别为 3 个月时 91.80±12.98、6 个月时 91.80±13.69、9-12 个月时 88.41±11.60。历史队列中 12 个月时的 MoDQ 和 MeDQ 评分分别为 86.35±20.34 和 86.58±18.27。MoDQ 的平均差值（MD（95%CI））为-4.670（-8.48 至-0.85）（p=0.0165），MeDQ 的 MD 为-1.83（-5.26 至 1.6）（p=0.29）。复合发育商（CoDQ）与平均 rSO2 呈负相关，与脑局部组织氧摄取率（CFTOE）呈正相关。在神经发育评估中，患有 HIE 和新生儿脑病（NE）（n=37/120）的新生儿的运动和智力 DQ 最低。在研究期间，NM 和 IVH 等临床类别改善了 DQ 评分。
通过适当的管理调整，将大脑 rSO2 维持在 55-85%之间，可以改善病因各异的脑病新生儿的神经发育评分，在 12 个月的随访中提高神经发育评分。
