Kanaprach Pasinee, Michel-Macias Carolina, Mazzarello Matthew, Mir Marina, Rampakakis Emmanouil, Wutthigate Punnanee, Simoneau Jessica, Villegas Daniela, Moore Shiran Sara, Shemie Sam D, Brossard-Racine Marie, Dancea Adrian, Bertolizio Gianluca, Wintermark Pia, Altit Gabriel
Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada,
Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada.
Neonatology. 2025 May 30:1-9. doi: 10.1159/000546675.
The aim of the study was to explore the relationship between near-infrared spectroscopy parameters (cerebral saturation [CSat] and corresponding cerebral fractional tissue oxygen extraction [cFTOE]) with resistive (RI) and pulsatility indices (PI) of the anterior cerebral artery (ACA) obtained simultaneously in neonates with congenital heart defect (CHD) during the first week of life.
Prospective observational study on neonates ≥35 weeks with CHD was conducted. Cerebral FTOE was based on concomitant pre-ductal oxygen saturation (SpO2) during CSat measurement. ACA was assessed via Doppler ultrasound (US). Continuous CSat/SpO2 monitoring was collected during the first week of life. Daily ACA Doppler was obtained from day 1-7.
A total of 142 concomitant measurements of NIRS and US parameters during the first week of life were collected in 34 neonates with various CHD. Mixed effect models showed significant association between CSat/cFTOE and time-corresponding RI-ACA (p = 0.02 and 0.005) and PI-ACA (p = 0.006 and 0.002), respectively. A 0.1-point increase in RI was associated to a 2.3% decrease in CSat and a 3-point increase in cFTOE. A 0.1-point increase in PI was associated to a 0.9% decrease in CSat and 1.1-point increase in cFTOE.
In neonates with CHD during their first week of life, lower CSat and higher cerebral FTOE were associated with elevated RI and PI values of the ACA obtained simultaneously. Future research should assess whether a multimodal bedside approach to monitoring cerebrovascular hemodynamics can facilitate early detection of cerebral hypoperfusion and prevent brain injury, as well as adverse neurodevelopmental outcomes in this vulnerable population.
本研究的目的是探讨在出生后第一周患有先天性心脏病（CHD）的新生儿中，近红外光谱参数（脑饱和度[CSat]和相应的脑分数组织氧摄取率[cFTOE]）与同时获得的大脑前动脉（ACA）的阻力指数（RI）和搏动指数（PI）之间的关系。
对孕周≥35周的患有CHD的新生儿进行前瞻性观察研究。脑FTOE基于CSat测量期间的同时期导管前氧饱和度（SpO2）。通过多普勒超声（US）评估ACA。在出生后第一周收集连续的CSat/SpO2监测数据。从第1天至第7天每天获取ACA多普勒测量值。
在34例患有各种CHD的新生儿中，共收集了出生后第一周期间142次近红外光谱和超声参数的同步测量数据。混合效应模型显示，CSat/cFTOE与时间对应的RI-ACA（p = 0.02和0.005）和PI-ACA（p = 0.006和0.002）之间分别存在显著关联。RI每增加0.1个单位与CSat降低2.3%和cFTOE增加3个单位相关。PI每增加0.1个单位与CSat降低0.9%和cFTOE增加1.1个单位相关。
在出生后第一周患有CHD的新生儿中，较低的CSat和较高的脑FTOE与同时获得的ACA的RI和PI值升高相关。未来的研究应评估多模式床边监测脑血管血流动力学方法是否能够促进脑灌注不足的早期检测，并预防该脆弱人群的脑损伤以及不良神经发育结局。
