Clinical and prognostic value of cerebral oximetry in newborns with congenital malformations in the perioperative period

• Teberdieva S.O.
• Lyubov’ V. Ushakova
• Artem A. Burov
• Anna R. Kirtbaya
• Kryuchko D.S.

Abstract

The aim of the study was to determine the clinical and prognostic value of the cerebral oximetry method in newborns with malformations of internal organs in the perioperative period.

Material and methods. 160 histories of newborns development were analyzed to determine predisposing factors to the development of perinatal CNS damage. Cerebral oximetry was performed in 68 patients. The chil­dren were divided into 3 groups: 1 group - newborns with malformations of internal organs (from the Depart­ment of Neonatal Surgery) and brain damage (n=20), 2 group - newborns with malformations of internal organs (from the department of neonatal surgery) without brain damage (n=20), 3 group - control group, - healthy term infants from the Department of Physiology of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation (n=28). All patients from groups 1 and 2 underwent surgical correction of malformations of internal organs in the early neonatal period (0-7 days of life). Cerebral oximetry for newborns with malformations of internal organs from Groups 1 and 2 was performed three times: 1 day of life, 1 postoperative and 7 postoperative days. Children from the control group of cerebral oximetry were performed singly in a dream, on average 2.1±1.2 days of life. Patients from all 3 groups underwent neurosonography.

Results. Analysis of 160 cases of neonatal disease revealed that CNS lesions occurred in 45% of cases (72/160 children). The following predisposing factors were identified: severe and moderate asphyxia at birth (odds ratio = 8), duration of anesthesia for more than 1 hour (odds ratio = 6), repeated surgery (odds ratio = 4), and duration of mechanical ventilation more than 2 days (odds ratio = 17). The analysis of the cerebral oximetry revealed differences between group 1 and the control group in both hemispheres for 1 day of life, 1 and 7 post­operative days, which were statistically significant (p<0.05). The differences between group 2 and the control group also turned out to be statistically significant, with the exception of the cerebral oximetry indicator for the right hemisphere for 1 postoperative day (p=0.0584). It should be noted that both in the preoperative period and on days 1 and 7 of the postoperative period, the level of oxygenation of the brain tissue in children with malfor­mations of internal organs was significantly higher than in healthy newborns. Interhemispheric asymmetry was estimated. Oscillations of the cerebral oximetry between the right hemisphere in the range of 1-2% have been revealed, both in the study groups with malformations of internal organs and in the control group.

Conclusion. The cerebral oxygenation in children with malformations of internal organs, included in our study, was higher in the preoperative and postoperative period than in healthy children, which could be one of the reasons for transient neurologic disorders. In addition, the development of disorders contributed to: the transferred asphyxia, the duration of anesthesia for more than an hour, repeated surgical interventions and the duration of mechanical ventilation for more than 48 hours.

Keywords:prematurity, post-discharge feeding, catch-up growth, artificial feeding, breast milk fortification

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