Near-Infrared Spectroscopy Monitoring, Superior Vena Cava Flow, and Neurodevelopmental Outcome at 2 years in a Cohort of Very Low-Birth-Weight Infants

Rosa Maria Cerbo; Simona Orcesi; Luigia Scudeller; Martina Borellini; Carolina Croci; Claudia Ravelli; Giulia Masa; Piermichele Paolillo; Paolo Manzoni; Umberto Balottin; Mauro Stronati

doi:10.1055/s-0036-1586103

American Journal of Perinatology, Table of Contents

Am J Perinatol 2016; 33(11): 1093-1098
DOI: 10.1055/s-0036-1586103

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Near-Infrared Spectroscopy Monitoring, Superior Vena Cava Flow, and Neurodevelopmental Outcome at 2 years in a Cohort of Very Low-Birth-Weight Infants

Rosa Maria Cerbo

¹Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

,

Simona Orcesi

²Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy

,

Luigia Scudeller

³Biostatistics and Clinical Epidemiology Unit, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy

,

Martina Borellini

¹Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

,

Carolina Croci

²Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy

⁴Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

,

Claudia Ravelli

²Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy

⁴Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

,

Giulia Masa

¹Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

,

Piermichele Paolillo

⁵Division of Neonatology and Neonatal Intensive Care, Casilino General Hospital, Roma, Italy

,

Paolo Manzoni

⁶Neonatology and Neonatal Intensive Care Unit, S. Anna Hospital, Turin, Italy

,

Umberto Balottin

²Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy

⁴Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

,

Mauro Stronati

¹Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

› Author Affiliations

Abstract

Objective We aimed at assessing the association between superior vena cava flow (SVCf), regional (cerebral) tissue oxygen saturation (rSO₂), and cerebral fractional oxygen extraction (CFOE) during the first 48 hours of life and 2-years neurodevelopmental outcome of very low-birth-weight infants (VLBW).

Methods We prospectively studied 60 VLBW infants admitted to our neonatal intensive care unit; rSO₂ was continuously monitored with near-infrared spectroscopy during the first 48 hours of life, SVCf was measured at 4 to 6, 12, 24, and 48 hours, and CFOE was calculated. Neurodevelopmental outcome was assessed at 24 months corrected age.

Results The mean gestational age at birth was 27.9 weeks (standard deviation: 2.4); 8 infants died in the first 3 months of life, 6 were lost to follow-up, 46 survived and were followed up. At 24 months, 6 (13%) and 7 (15.2%) infants developed minor and major sequelae, respectively. Infants who died had higher CFOE (p < 0.001) and lower SVCf (p < 0.001) than infants surviving with sequelae. In turn, these had higher SVCf between 24 and 48 hours than those without sequelae (p < 0.001).

Conclusion SVCf, rSO_2, and CFOE patterns in the first days of life suggest cerebral hyperperfusion, related to loss of autoregulation and/or use of inotropic drugs, as a potential mechanism of cerebral injury.

Keywords

preterm - superior vena cava flow - NIRS monitoring - neurodevelopmental outcome - inotropic drugs

Full Text

References

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