新生儿脑病治疗性低温期间的经皮二氧化碳监测

Gangaram-Panday Norani H, van Essen Tanja, van Weteringen Willem, Dremmen Marjolein H G, Goos Tom G, de Jonge Rogier C J, Reiss Irwin K M

Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Pediatr Res. 2022 Dec;92(6):1724-1730. doi: 10.1038/s41390-022-02035-6. Epub 2022 Mar 29.

BACKGROUND

In neonates with post-asphyxial neonatal encephalopathy, further neuronal damage is prevented with therapeutic hypothermia (TH). In addition, fluctuations in carbon dioxide levels have been associated with poor neurodevelopmental outcome, demanding close monitoring. This study investigated the accuracy and clinical value of transcutaneous carbon dioxide (tcPCO) monitoring during TH.

METHODS

In this retrospective cohort study in neonates, agreement between arterial carbon dioxide (PaCO) values and tcPCO measurements during TH was determined. TcPCO levels during the first 24 h of hypothermia were tested for an association with ischemic brain injury on magnetic resonance imaging (MRI).

RESULTS

Thirty-four neonates were included. Agreement (bias (95% limits of agreement)) between tcPCO and PaCO levels was 3.9 (-12.4-20.2) mm Hg. No relation was found between the body temperature and tcPCO levels. TcPCO levels differed significantly between patients with considerable and minimal damage on MRI; after 6 h (P = 0.02) and 9 h (P = 0.04).

CONCLUSIONS

Although tcPCO provided a limited estimation of PaCO, it can be used for trend monitoring during TH. TcPCO levels after birth could provide an early indicator of ischemic brain injury. This relation should be investigated in large prospective studies, in which adjustments for confounders can be made.

IMPACT

Transcutaneous carbon dioxide measurements during therapeutic hypothermia in neonates show limited accuracy similar to measurements reported in normothermic neonates and can be used for trend monitoring. Low transcutaneous carbon dioxide levels during the first 24 h were associated with considerable ischemic brain injury on MRI. The value of transcutaneous carbon dioxide measurements during the first 24 h as an indicator of considerable ischemic brain injury on MRI should be investigated in future studies, adjusting for confounders. Transcutaneous oxygen measurements during therapeutic hypothermia showed an inaccuracy that could not be related to a low body temperature.

背景

在患有窒息后新生儿脑病的新生儿中，治疗性低温（TH）可预防进一步的神经元损伤。此外，二氧化碳水平的波动与不良的神经发育结局相关，需要密切监测。本研究调查了TH期间经皮二氧化碳（tcPCO）监测的准确性和临床价值。

方法

在这项针对新生儿的回顾性队列研究中，确定了TH期间动脉二氧化碳（PaCO）值与tcPCO测量值之间的一致性。对低温治疗最初24小时内的tcPCO水平进行测试，以确定其与磁共振成像（MRI）上缺血性脑损伤的相关性。

结果

纳入了34例新生儿。tcPCO与PaCO水平之间的一致性（偏差（一致性的95%限度））为3.9（-12.4至20.2）mmHg。未发现体温与tcPCO水平之间存在关联。MRI显示有明显损伤和轻微损伤的患者之间，tcPCO水平存在显著差异；在6小时后（P = 0.02）和9小时后（P = 0.04）。

结论

尽管tcPCO对PaCO的估计有限，但它可用于TH期间的趋势监测。出生后的tcPCO水平可提供缺血性脑损伤的早期指标。这种关系应在大型前瞻性研究中进行调查，以便能够对混杂因素进行调整。

影响

新生儿治疗性低温期间的经皮二氧化碳测量显示出与正常体温新生儿报告的测量相似的有限准确性，可用于趋势监测。最初24小时内较低的经皮二氧化碳水平与MRI上明显的缺血性脑损伤相关。未来的研究应在调整混杂因素的情况下，调查最初24小时内经皮二氧化碳测量作为MRI上明显缺血性脑损伤指标的价值。治疗性低温期间的经皮氧测量显示出的不准确性与低体温无关。