Division of Neonatology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey.
Department of Radiology, Ankara City Hospital, Ankara, Turkey.
Turk J Med Sci. 2023 Feb;53(1):225-232. doi: 10.55730/1300-0144.5577. Epub 2023 Feb 22.
The prediction of adverse conditions in the preterm neonatal brain might be improved by cerebral monitoring using combined measures of cerebral function, including oxygenation and blood flow parameters. To perform the consecutive measurements of the resistive index (RI) from the anterior cerebral artery (ACA) within the first week of life and to evaluate the association of these measurements with cerebral oxygen saturation (Csat) detected by near-infrared spectroscopy (NIRS).
This prospective cohort study enrolled very preterm infants, <32 weeks of gestational age, admitted to a tertiary neonatal intensive care unit. Csat levels were continuously monitored using NIRS for 72 h after birth. ACA RI measurements were obtained on the first, third, and seventh days of life by using transcranial Doppler ultrasound. These measurements were also compared between infants with and without unfavorable outcomes, including severe intraventricular hemorrhage (IVH) and early mortality.
A total of 96 preterm infants with Csat and ACA RI measurements were analyzed. Age at birth was 28.3 ± 1.9 weeks and birth weight was 1090 ± 305 g. The mean Csat of the infants was 77.1% ± 8.2% during the first 72 h of life. Mean ACA RI values were 0.76 ± 0.10, 0.75 ± 0.08, and 0.77 ± 0.08 on the first, third, and seventh days of life, respectively. RI on the first day of life was significantly higher in infants delivered by cesarian section than in those delivered vaginally (0.77 vs. 0.69; p = 0.017). Infants who died earlier had significantly higher ACA RI values on the first day than infants who survived beyond the first 7 postnatal days (0.83 vs. 0.76; p < 0.001).
There was no association between ACA RI and Csat in the early period of life. ACA RI values on the first postnatal day might be significant for predicting early mortality in very preterm infants.
通过联合监测脑功能的氧合和血流参数等指标进行脑监测，可能会改善早产儿脑的不良预后预测。在生命的第一周内，连续测量大脑前动脉（ACA）的阻力指数（RI），并评估这些测量值与近红外光谱（NIRS）检测到的脑氧饱和度（Csat）之间的相关性。
本前瞻性队列研究纳入了胎龄<32 周的极早产儿，在出生后 72 小时内通过 NIRS 连续监测 Csat 水平。在出生后的第 1、3、7 天，通过经颅多普勒超声获取 ACA RI 测量值。这些测量值还与预后不良的婴儿（包括严重脑室出血（IVH）和早期死亡率）进行了比较。
共分析了 96 例有 Csat 和 ACA RI 测量值的早产儿。出生时的年龄为 28.3±1.9 周，出生体重为 1090±305 g。出生后前 72 小时，婴儿的平均 Csat 为 77.1%±8.2%。第 1、3、7 天的平均 ACA RI 值分别为 0.76±0.10、0.75±0.08 和 0.77±0.08。经剖宫产分娩的婴儿第 1 天的 RI 显著高于阴道分娩的婴儿（0.77 比 0.69；p=0.017）。在出生后第 1 天死亡的婴儿的 ACA RI 值明显高于在第 7 天以后存活的婴儿（0.83 比 0.76；p<0.001）。
在生命的早期，ACA RI 与 Csat 之间没有关联。在极早产儿中，第 1 天的 ACA RI 值可能对预测早期死亡率有意义。
