Cardiorespiratory status and cerebral oxygenation in neonates with respiratory disorders

Abstract

Objective - to assess the relationship between the cardiorespiratory status and cerebral oxygenation and to identify physiological determinants of cerebral oxegenation (crSO2) in newborns with respiratory disorders.

Material and methods. 74 newborns with respiratory disorders were included (36 late preterm and 38 full-term) in observational cohort study. Recording of crSO2 using the INVOS 5100C tissue oximeter (Covidien, Medtronic, USA) was done along standard vital signs monitoring. Patients were assigned to three groups according the hemodynamic support: 1st - infants treated by the combination of dopamine (dose ≥10 pg/kg min) and vasopressor (adrenaline or norepinephrine in a dose of ≥0.05 pg/kg min), 2nd group received dopamine in dose of ≥10 pg/kg min and 3rd - dopamine in dose less than 10 pg/kg min. Cardiorespiratory determinants of crSO2 were found in a multiple linear regression.

Results. crSO2 was lowest in the 1st group - 77 (67; 85)% vs 87 (79; 92)% in 2nd and 81 (76; 87)% in 3rd groups, p=0.0066. Cerebral fractional oxygen extraction (cFTOE) was highest in 1st group 0.21 (0.12; 0.32) vs 0.12 (0.05; 0.23) and 0.16 (0.10; 0.23) in 2nd and 3rd respectively, p=0.0251. Multiple regression revealed significant positive correlation between crSO2 and pCO2 (p=0.0027), cFTOE and Lactate (p=0.0186) and negative between crSO2, MAP (p=0.0479) and Lactate (p=0.0091); as well as cFTOE and pCO2 (p=0.0006). The level of crSO2 ≤66% in newborns on mechanical ventilation and dopamine + vasopressor may indicate hypocapnia (pCO2 <35 mm Hg) with 40% sensitivity and 100% specificity (AUC=0.670, p=0.0343).

Conclusion. Patients with the most compromised cardiorespiratory status had lower levels of crSO2 and higher levels of cFTOE because of hypocapnia and mechanical ventilation with relatively high MAP combined with tissue hypoperfusion.

Keywords:cardiorespiratory status, cerebral oxygenation, newborn, intensive care

Funding. The study had no sponsor support.

Conflict of interests. The authors declare no conflict of interests.

For citation: Sankovets D.N., Vitushka A.M. Cardiorespiratory status and cerebral oxygenation in neonates with respiratory disorders. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2020; 8 (2): 13-20. DOI: 10.33029/2308-2402-2020-8-2-13-20 (in Russian)

References

1. Sun B., Ma L., Liu X., Gao X., Ni L. Development of neonatal respiratory and intensive care: Chinese perspectives. Neonatology. 2012; 101 (2): 77–82.

2. Gleason S.A., Juul S.E., Avery’s diseases of the newborn. 10th ed. Phjladelphia: Elsevier, 2018: 1950 p.

3. Kleinman C.S., Seri I. Hemodynamics and Cardiology: Neonatology Questions and Controversies. 2nd ed. Philadelphia: Elsevier, 2012: 576 p.

4. Kurth C.D., McCann J.C., Wu J., Miles L., Loepke A.W. Cerebral oxygen saturation-time threshold for hypoxic-ischemic injury in piglets. Anesth Analg. 2009; 108 (4): 1268-77.

5. van Bel F., Lemmers P., Naulaers G. Monitoring neonatal regional cerebral oxygen saturation in clinical practice: value and pitfalls. Neonatology. 2008; 94 (4): 237-44.

6. Toet M.C., Flinterman A., Laar I., Vries J.W., Bennink G.B., Uiter-waal C.S., et al. Cerebral oxygen saturation and electrical brain activity before, during, and up to 36 hours after arterial switch procedure in neonates without pre-existing brain damage: its relationship to neurodevelopmental outcome. Exp Brain Res. 2005; 165 (3): 343-50.

7. Pellicer A., Bravo Mdel C. Near-infrared spectroscopy: a methodology-focused review. Semin Fetal Neonatal Med. 2011; 16 (1): 42-9.

8. Lemmers P.M.A. The clinical use of near infrared spectroscopy-monitored cerebral oxygen saturation and extraction in the preterm infant [Electronic resource]. Netherlands: Utrecht University Repository, 2010: 144 p. URL: http://dspace.library.uu.nl/handle/1874/40574 (date of access October 10, 2014).

9. Dix L.M., van Bel F., Lemmers P.M. Monitoring Cerebral Oxygenation in Neonates: An Update. Front Pediatr. 2017; 5: 46.

10. Pellicer A., Greisen G., Benders M., Claris O., Dempsey E., Fumagalli M., et al. The SafeBoosC phase II randomised clinical trial: a treatment guideline for targeted near-infrared-derived cerebral tissue oxygenation versus standard treatment in extremely preterm infants. Neonatology. 2013; 104 (3): 171-8.

11. Kreeger R.N., Ramamoorthy C., Nicolson S.C., Ames W.A., Hirsch R., Peng L.F., et al. Evaluation of pediatric near-infrared cerebral oximeter for cardiac disease. Ann Thorac Surg. 2012; 94 (5): 1527-33.

12. The blood gas handbook. In: Radiometer Medical ApS. Bronshoj, 2011: 112 p.

13. Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr. 2017; 5: 201.

14. Andersen C.C., Hodyl N.A., Kirpalani H.M., Stark M.J.A Theoretical and practical approach to defining "adequate oxygenation" in the preterm newborn. Pediatrics. 2017; 139 (4): e20161117.

15. Pellicer A., Valverde E., Elorza M.D., Madero R., Gaya F., Quero J., et al. Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded, clinical trial. Pediatrics. 2005; 115 (6): 1501-12.

16. Eriksen V.R., Rasmussen M.B., Hahn G.H., Greisen G. Dopamine therapy does not affect cerebral autoregulation during hypotension in newborn piglets. PLoS One. 2017; 12 (1): e0170738.

17. Gleason C.A., Robinson R., Harris A.P., Mayock D.E., Traystman R.J. Cerebrovascular effects of intravenous dopamine infusions in fetal sheep. J Appl Physiol (1985). 2002; 92 (2): 717-24.

18. Nachar R.A., Booth E.A., Friedlich P., Borzage M., Soleymani S., Wider M.D., et al. Dose-dependent hemodynamic and metabolic effects of vasoactive medications in normotensive, anesthetized neonatal piglets. Pediatr Res. 2011; 70 (5): 473-9.

19. Peacock J.L., Peacock PJ. Oxford Handbook of Medical Statistics. 1st ed. New York: Oxford University Press, 2011: 544 p.

20. Vanderhaegen J., Naulaers G., Vanhole C., De Smet D., Van Huffel S., Vanhaesebrouck S., et al. The effect of changes in tPCO2 on the fractional tissue oxygen extraction - as measured by near-infrared spectroscopy - in neonates during the first days of life. Eur J Paediatr Neurol. 2009; 13 (2): 128-34.

21. Greisen G. Autoregulation of cerebral blood flow in newborn babies. Early Hum Dev. 2005; 81 (5): 423-8.

22. Volpe J.J., Inder T.E., Darras B.T., de Vries L.S., du Plessis A.J., Neil J.J., et al. Volpe’s Neurology of the Newborn. 6th ed. Philadelpia: Elsevier, 2018: 1950 p.

23. Milan A., Freato F., Vanzo V., Chiandetti L., Zaramella P. Influence of ventilation mode on neonatal cerebral blood flow and volume. Early Hum Dev. 2009; 85 (7): 415-9.

24. Munro M.J., Walker A.M., Barfield C.P. Hypotensive extremely low birth weight infants have reduced cerebral blood flow. Pediatrics. 2004; 114 (6): 1591-6.

25. Tsuji M., Saul J.P., du Plessis A., Eichenwald E., Sobh J., Crocker R., et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics. 2000; 106 (4): 625-32.

26. Evans N., Osborn D., Kluckow M. Preterm circulatory support is more complex than just blood pressure. Pediatrics. 2005; 115 (4): 1114-5; author reply 1115-6.

27. Demel A., Feilke K., Schoning M., Wolf M., Poets C.F., Franz A.R. Healthy term and moderately preterm infants have similar cerebral oxygen saturation and cerebral blood flow volumes during early post-natal transition. Acta Paediatr. 2015; 104 (8): e330-6.

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CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

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