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Autoregulation preterm

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https://www.readbyqxmd.com/read/29908901/neonatal-rbc-transfusions-do-benefits-outweigh-risks
#1
REVIEW
Iman F Iskander, Khaled M Salama, Rasha M Gamaleldin, Jerard Seghatchian
Preterm neonates represent one of the most transfused categories of patients. Their target hematocrits, however, are mainly based on expert opinion. The risk of transfusions are very high in the smallest preterm baby with a weak immune response, immature antioxidant ability, fragile germinal matrix and impaired cerebral autoregulation, yet red cell transfusions remain the only life saving measure in the baby with symptomatic anemia. Minimizing phlebotomy losses, following a restrictive transfusion policy and using screened, leukocyte depleted, irradiated, single donor blood remain the best means of avoiding the possible risks while maximizing the benefits of red cell transfusions in the preterm newborn...
May 9, 2018: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29868521/measuring-near-infrared-spectroscopy-derived-cerebral-autoregulation-in-neonates-from-research-tool-toward-bedside-multimodal-monitoring
#2
REVIEW
Liesbeth Thewissen, Alexander Caicedo, Petra Lemmers, Frank Van Bel, Sabine Van Huffel, Gunnar Naulaers
Introduction: Cerebral autoregulation (CAR), the ability of the human body to maintain cerebral blood flow (CBF) in a wide range of perfusion pressures, can be calculated by describing the relation between arterial blood pressure (ABP) and cerebral oxygen saturation measured by near-infrared spectroscopy (NIRS). In literature, disturbed CAR is described in different patient groups, using multiple measurement techniques and mathematical models. Furthermore, it is unclear to what extent cerebral pathology and outcome can be explained by impaired CAR...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29723927/cardiovascular-impact-of-intravenous-caffeine-in-preterm-infants
#3
Jacqueline Huvanandana, Cindy Thamrin, Alistair L McEwan, Murray Hinder, Mark B Tracy
AIM: To evaluate the acute effect of intravenous caffeine on heart rate and blood pressure variability in preterm infants. METHODS: We extracted and compared linear and non-linear features of heart rate and blood pressure variability at two timepoints: prior to and in the two hours following a loading dose of 10 mg/kg caffeine base. RESULTS: We studied 31 preterm infants with arterial blood pressure data and 25 with electrocardiogram data, and compared extracted features prior to and following caffeine administration...
May 3, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29695729/cerebral-oxygen-saturation-and-peripheral-perfusion-in-the-extremely-premature-infant-with-intraventricular-and-or-pulmonary-haemorrhage-early-in-life
#4
Thierry P Beausoleil, Marie Janaillac, Keith J Barrington, Anie Lapointe, Mathieu Dehaes
Extremely preterm infants are at higher risk of pulmonary (PH) and intraventricular (IVH) haemorrhage during the transitioning physiology due to immature cardiovascular system. Monitoring of haemodynamics can detect early abnormal circulation that may lead to these complications. We described time-frequency relationships between near infrared spectroscopy (NIRS) cerebral regional haemoglobin oxygen saturation (CrSO2 ) and preductal peripheral perfusion index (PI), capillary oxygen saturation (SpO2 ) and heart rate (HR) in extremely preterm infants in the first 72 h of life...
April 25, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29454185/preterm-infants-undergoing-laparotomy-for-necrotizing-enterocolitis-or-spontaneous-intestinal-perforation-display-evidence-of-impaired-cerebrovascular-autoregulation
#5
Sara J Kuik, Michelle E van der Laan, Margot T Brouwer-Bergsma, Jan B F Hulscher, Anthony R Absalom, Arend F Bos, Elisabeth M W Kooi
BACKGROUND: Preterm infants requiring surgery are at risk of impaired neurocognitive development caused, possibly, by cerebral ischemia associated with impaired cerebrovascular autoregulation (CAR). We evaluated CAR before, during, and after laparotomy. STUDY DESIGN: This was a hypothesis generating prospective observational cohort study. SUBJECTS: We included preterm infants requiring surgery for necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP)...
March 2018: Early Human Development
https://www.readbyqxmd.com/read/29369068/applications-of-near-infrared-spectroscopy-in-the-neonate
#6
Aisling A Garvey, Eugene M Dempsey
PURPOSE OF REVIEW: There has been a significant increase in the utilization of NIRS in neonatal care over the last few years, with some centers now routinely utilizing this monitoring technique for direct intervention at the bedside. In this review, we provide a summary of the most up-to-date evidence on near infrared spectroscopy utilization, with particular emphasis on measurement of cerebral oxygenation in preterm infants. RECENT FINDINGS: There have been significant advances in the technology, leading to an increase in the number of available devices and in the use of this monitoring tool to reduce cerebral injury in preterm infants...
April 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28902182/gestational-age-dependent-relationship-between-cerebral-oxygen-extraction-and-blood-pressure
#7
Zachary A Vesoulis, Steve M Liao, Amit M Mathur
BackgroundPremature infants may lack mature cerebrovascular autoregulatory function and fail to adapt oxygen extraction to decreasing systemic perfusion.MethodsInfants ≤28 weeks of gestational age (GA) were recruited. Systemic oxygen saturation (SpO2 ), mean arterial blood pressure (MABP), and cerebral saturation (near-infrared spectroscopy, SctO2 ) were measured continuously over the first 72 h. Resulting data underwent error-processing. For each remaining 10 m window, the mean MABP and fractional tissue oxygen extraction (FTOE) were calculated...
December 2017: Pediatric Research
https://www.readbyqxmd.com/read/28673382/rational-use-of-dopamine-in-hypotensive-newborns-improving-our-understanding-of-the-effect-on-cerebral-autoregulation
#8
Vibeke Ramsgaard Eriksen
Hypotension in critically ill newborn infants is associated with higher mortality and higher risk of cerebral injuries. Yet treating hypotension has never been shown to improve outcomes. In fact, some studies have found that hypotensive newborn infants who were treated with dopamine fared worse than a comparable group of newborn infants who were not. Therefore, a concern has been raised that dopamine might cause the observed adverse outcomes. Cerebral autoregulation is a protective mechanism that maintains a fairly constant cerebral blood flow despite fluctuations in blood pressure...
July 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28639837/measuring-cerebrovascular-autoregulation-in-preterm-infants-using-near-infrared-spectroscopy-an-overview-of-the-literature
#9
Elisabeth M W Kooi, Elise A Verhagen, Jan Willem J Elting, Marek Czosnyka, Topun Austin, Flora Y Wong, Marcel J H Aries
The preterm born infant's ability to regulate its cerebral blood flow (CBF) is crucial in preventing secondary ischemic and hemorrhagic damage in the developing brain. The relationship between arterial blood pressure (ABP) and CBF estimates, such as regional cerebral oxygenation as measured by near-infrared spectroscopy (NIRS), is an attractive option for continuous non-invasive assessment of cerebrovascular autoregulation. Areas covered: The authors performed a literature search to provide an overview of the current literature on various current clinical practices and methods to measure cerebrovascular autoregulation in the preterm infant by NIRS...
August 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/28421173/cerebral-autoregulation-brain-injury-and-the-transitioning-premature-infant
#10
REVIEW
Zachary A Vesoulis, Amit M Mathur
Improvements in clinical management of the preterm infant have reduced the rates of the two most common forms of brain injury, such as severe intraventricular hemorrhage and white matter injury, both of which are contributory factors in the development of cerebral palsy. Nonetheless, they remain a persistent challenge and are associated with a significant increase in the risk of adverse neurodevelopment outcomes. Repeated episodes of ischemia-reperfusion represent a common pathway for both forms of injury, arising from discordance between systemic blood flow and the innate regulation of cerebral blood flow in the germinal matrix and periventricular white matter...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28384837/the-impact-of-integrated-evaluation-of-hemodynamics-on-management-of-preterm-infants-with-late-onset-compromised-systemic-circulation
#11
Reem Amer, Reem Kalash, Mary M Seshia, Yasser N Elsayed
Objectives To study the impact of integrated evaluation of hemodynamics (IEH), using targeted neonatal echocardiography (TNE), cerebral regional tissue oxygenation (crRTO), and fractional oxygen extraction (FOE), using near-infrared spectroscopy (NIRS) on the management of infants with late-onset compromised systemic circulation (LCSC), and evaluation of the hemodynamic characteristics. Study Design Retrospective cohort study comparing infants with LCSC who underwent IEH (April 2014 to May 2016) with an earlier EPOCH who did not undergo IEH (January 2012 to March 2014)...
August 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28211916/role-of-endothelial-nitric-oxide-synthase-and-endothelin-1-polymorphism-genes-with-the-pathogenesis-of-intraventricular-hemorrhage-in-preterm-infants
#12
Dawid Szpecht, Janusz Gadzinowski, Agnieszka Seremak-Mrozikiewicz, Grażyna Kurzawińska, Marta Szymankiewicz
In the pathogenesis of neonatal intraventricular hemorrhage (IVH) in preterm infants, an important role is played by changes in venous and arterial cerebral flows. It has been shown that the ability of autoregulation of cerebral flows in response to variations in arterial blood pressure in preterm infants is impaired. This impaired autoregulation causes an increased risk of germinal matrix rupture and IVH occurrence. We examined three polymorphisms of genes, related to regulation of blood flow, for an association with IVH in 100 preterm infants born from singleton pregnancy, before 32 + 0 weeks of gestation, exposed to antenatal steroids therapy, and without congenital abnormalities...
February 13, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28009319/-ultrasound-monitoring-of-central-and-cerebral-hemodynamics-during-the-treatment-of-arterial-hypotension-in-preterm-infants
#13
A Zakrevskyy, O Karapetyan, V Agashkov, K Kosenko
The purpose of the study was to evaluate and identify patterns of changes in central and cerebral hemodynamics in neonates with low and extremely low birth weight and birth asphyxia, in order to achieve the early diagnosis of disorders of the central hemodynamics and autoregulation of cerebral blood flow, for timely fluid correction and inotropic therapy. Observation data on 44 preterm infants who were treated at the Kharkiv City Perinatal Centre and Regional Children's Clinical Hospital №1 of Kharkiv has been analyzed...
November 2016: Georgian Medical News
https://www.readbyqxmd.com/read/27924521/effects-of-different-surfactant-administrations-on-cerebral-autoregulation-in-preterm-infants-with-respiratory-distress-syndrome
#14
RANDOMIZED CONTROLLED TRIAL
Xu-Fang Li, Ting-Ting Cheng, Rui-Lian Guan, Hong Liang, Wei-Neng Lu, Jing-Hua Zhang, Mei-Yi Liu, Xin Yu, Jun Liang, Li Sun, Lian Zhang
To treat respiratory distress syndrome, surfactant is currently delivered via less invasive surfactant administration (LISA) or INtubation SURfactant Extubation (INSURE). The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation. Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation (ScO2 ), and the mean arterial blood pressure (MABP) was simultaneously recorded. Of 44 preterm infants included, the surfactant was administrated to 22 via LISA and 22 via INSURE...
December 2016: Journal of Huazhong University of Science and Technology. Medical Sciences
https://www.readbyqxmd.com/read/27603562/near-infrared-spectroscopy-for-detection-of-a-significant-patent-ductus-arteriosus
#15
Valerie Y Chock, Laura A Rose, Jeanet V Mante, Rajesh Punn
BACKGROUND: Near-infrared spectroscopy (NIRS) may assist with characterization of a hemodynamically significant patent ductus arteriosus (hsPDA) by measuring cerebral and renal saturation (Csat and Rsat) levels. We hypothesized that Csat and Rsat in preterm infants with an hsPDA would be decreased compared to those with no PDA or nonsignificant PDA. METHODS: This non a-priori designed study retrospectively investigated clinical and ECHO characteristics of preterm infants <29 wk gestation who underwent routine NIRS monitoring...
November 2016: Pediatric Research
https://www.readbyqxmd.com/read/27104347/the-effect-of-maternal-antihypertensive-drugs-on-the-cerebral-renal-and-splanchnic-tissue-oxygen-extraction-of-preterm-neonates
#16
Anne E Richter, Trijntje E Schat, Koenraad N J A Van Braeckel, Sicco A Scherjon, Arend F Bos, Elisabeth M W Kooi
BACKGROUND: Drugs with antihypertensive action are frequently used in obstetrics for the treatment of preeclampsia (labetalol) and tocolysis (nifedipine) or for neuroprotection (MgSO4), and may affect the hemodynamics of preterm born neonates. OBJECTIVE: The aim of this study was to assess whether maternal antihypertensive drugs affect multisite oxygenation levels of the neonate. METHODS: Eighty preterm neonates of ≤32 weeks of gestational age were monitored using near-infrared spectroscopy...
2016: Neonatology
https://www.readbyqxmd.com/read/26782253/can-the-assessment-of-spontaneous-oscillations-by-near-infrared-spectrophotometry-predict-neurological-outcome-of-preterm-infants
#17
André Stammwitz, Kurt von Siebenthal, Hans U Bucher, Martin Wolf
The aim was to assess the correlation between cerebral autoregulation and outcome. Included were 31 preterm infants, gestational age 26 1/7 to 32 2/7 and <24 h life. Coherence between cerebral total haemoglobin (tHb) or oxygenation index (OI) measured by near-infrared spectrophotometry (NIRS) and systemic heart rate (HR) or arterial blood pressure (MAP) was calculated as a measure of autoregulation. In contrast to previous studies, low coherences in the first 24 h were significantly associated with intraventricular haemorrhage, death or abnormal neurodevelopmental outcome at 18 months or later...
2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/26782252/characterizing-fluctuations-of-arterial-and-cerebral-tissue-oxygenation-in-preterm-neonates-by-means-of-data-analysis-techniques-for-nonlinear-dynamical-systems
#18
Stefan Kleiser, Marcin Pastewski, Tharindi Hapuarachchi, Cornelia Hagmann, Jean-Claude Fauchère, Ilias Tachtsidis, Martin Wolf, Felix Scholkmann
The cerebral autoregulatory state as well as fluctuations in arterial (SpO2) and cerebral tissue oxygen saturation (StO2) are potentially new relevant clinical parameters in preterm neonates. The aim of the present study was to test the investigative capabilities of data analysis techniques for nonlinear dynamical systems, looking at fluctuations and their interdependence. StO2, SpO2 and the heart rate (HR) were measured on four preterm neonates for several hours. The fractional tissue oxygenation extraction (FTOE) was calculated...
2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/26711678/dopamine-treatment-during-acute-hypoxia-is-neuroprotective-in-the-developing-sheep-brain
#19
N Brew, A Azhan, I den Heijer, M Boomgardt, G I Davies, I Nitsos, S L Miller, A M Walker, D W Walker, F Y Wong
Dopamine is often used to treat hypotension in preterm infants; these infants are at risk of developing brain injury due to impaired autoregulation and cerebral hypoperfusion. However the effects of dopamine on the immature brain under conditions of cerebral hypoxia are not known. We hypothesized that pretreatment with dopamine would protect the immature brain from injury caused by cerebral hypoxia. Preterm fetal sheep were used to determine the effects of intravenous dopamine on hypoxia-induced brain injury...
March 1, 2016: Neuroscience
https://www.readbyqxmd.com/read/26571222/a-novel-method-for-assessing-cerebral-autoregulation-in-preterm-infants-using-transfer-function-analysis
#20
Zachary A Vesoulis, Steve M Liao, Shamik B Trivedi, Nathalie El Ters, Amit M Mathur
BACKGROUND: Autoregulatory dysfunction is an important contributor to brain injury in premature infants, particularly intraventricular hemorrhage (IVH). The autoregulatory system acts as a filter that dampens the systemic blood flow to follow a normal cerebral perfusion profile. METHODS: Simultaneous arterial blood pressure and cerebral near-infrared spectroscopy (NIRS) data were collected from infants born before 28 wk estimated gestational age. The resulting data were preprocessed and then divided into nonoverlapping 20-min epochs...
March 2016: Pediatric Research
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