Chao Howard, Acosta Sebastian, Rusin Craig, Rhee Christopher
Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
Children (Basel). 2023 Aug 9;10(8):1361. doi: 10.3390/children10081361.
Premature infants are born with immature cerebral autoregulation function and are vulnerable to pressure passive cerebral circulation and subsequent brain injury. Measurements derived from near-infrared spectroscopy (NIRS) have enabled continuous assessment of cerebral vasoreactivity. Although NIRS has enabled a growing field of research, the lack of clear standardization in the field remains problematic. A major limitation of current literature is the absence of a comparative analysis of the different methodologies.
To determine the relationship between NIRS-derived continuous indices of cerebral autoregulation in a cohort of extremely low birth weight (ELBW) infants.
Premature infants of birth weight 401-1000 g were studied during the first 72 h of life. The cerebral oximetry index (COx), hemoglobin volume index (HVx), and tissue oxygenation heart rate reactivity index (TOHRx) were simultaneously calculated. The relationship between each of the indices was assessed with Pearson correlation.
Fifty-eight infants with a median gestational age of 25.8 weeks and a median birth weight of 738 g were included. Intraventricular hemorrhage (IVH) was detected in 33% of individuals. COx and HVx demonstrated the highest degree of correlation, although the relationship was moderate at best (r = 0.543, < 0.001). No correlation was found either between COx and TOHRx (r = 0.318, < 0.015) or between HVx and TOHRx (r = 0.287, < 0.029). No significant differences in these relationships were found with respect to IVH and no IVH in subgroup analysis.
COx, HVx, and TOHRx are not numerically equivalent. Caution must be applied when interpreting or comparing results based on different methodologies for measuring cerebral autoregulation. Uniformity regarding data acquisition and analytical methodology are needed to firmly establish a gold standard for neonatal cerebral autoregulation monitoring.
早产儿出生时脑自动调节功能不成熟，易受压力被动性脑循环及随后的脑损伤影响。近红外光谱（NIRS）测量能够对脑血管反应性进行连续评估。尽管NIRS推动了一个不断发展的研究领域，但该领域缺乏明确的标准化仍然是个问题。当前文献的一个主要局限是缺乏对不同方法的比较分析。
确定一组极低出生体重（ELBW）婴儿中，NIRS得出的脑自动调节连续指标之间的关系。
对出生体重401 - 1000 g的早产儿在出生后72小时内进行研究。同时计算脑氧饱和度指数（COx）、血红蛋白体积指数（HVx）和组织氧合心率反应指数（TOHRx）。用Pearson相关性评估各指标之间的关系。
纳入了58例婴儿，中位胎龄为25.8周，中位出生体重为738 g。33%的个体检测到脑室内出血（IVH）。COx和HVx显示出最高程度的相关性，尽管这种关系充其量只是中等程度（r = 0.543，P < 0.001）。在COx与TOHRx之间（r = 0.318，P < 0.015）或HVx与TOHRx之间（r = 0.287，P < 0.029）均未发现相关性。在亚组分析中，就IVH和无IVH而言，这些关系未发现显著差异。
COx、HVx和TOHRx在数值上并不等同。在基于测量脑自动调节的不同方法来解释或比较结果时必须谨慎。需要在数据采集和分析方法上保持一致，以牢固确立新生儿脑自动调节监测的金标准。
