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Regional tissue oxygenation in association with duration of hypoxaemia and haemodynamic variability in preterm neonates
  1. Anna Petrova,
  2. Rajeev Mehta
  1. Department of Pediatrics, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  1. Correspondence to Dr Anna Petrova, UMDNJ/Robert Wood Johnson Medical School, Department of Pediatrics, One Robert Wood Johnson Place, MEB 236, New Brunswick, NJ 08903, USA; petroran{at}umdnj.edu

Abstract

Objective To assess the effect of the duration of spontaneous hypoxic episodes and variations in haemodynamic parameters on cerebral and renal tissue oxygenation (rSo2C and rSo2R) in clinically stable preterm infants.

Design Observational study.

Setting Neonatal intensive care unit of a university-affiliated children's hospital.

Patients rSo2C and rSo2R and haemodynamic parameters were recorded for 2–3 h (once or twice) in clinically stable preterm neonates (n=10) using near-infrared spectroscopy, GE DASH 4000 and Bedmaster Software.

Main outcome measures rSo2C and rSo2R and fractional oxygen extraction (cerebral and renal fractional oxygen extraction: FOE-C and FOE-R, respectively) in association with the duration of pulse oximetry desaturation (pulse oximetry saturations (Sao2) ≤84%), bradycardia (heart rate ≤90 beats/min) and hypotension (mean blood pressure (MBP) <30 mm Hg).

Results Among the 14 sets of recorded measurements, 128 hypoxic episodes with 5–10 (n=41), 15–20 (n=26), 25–30 (n=78), 35–40 (n=14), 45–50 (n=25) and ≥55 s (n=16) duration were identified. Prolongation of hypoxic episodes for more than 30 s was associated with major reductions in Sao2, rSo2C and rSo2R without any significant changes in the regional FOE. Bradycardia occurred during 43.8% of hypoxaemic episodes of ≥55 s duration (p<0.01) and impacted the severity of the tissue deoxygenation. Decreased rSo2R and increased FOE-R were observed in association with mild hypotension irrespective of the systemic oxygenation status.

Conclusions Prolongation of hypoxaemia contributes to the severity of the deoxygenation (systemic and regional) and development of bradycardia. In stable preterm neonates, mild decreases in MBP independently affect the renal but not cerebral tissue oxygenation and oxygen utilisation.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent Obtained from the parents.

  • Ethics approval Ethics approval was obtained from the University of Medicine and Dentistry in New Jersey—Robert Wood Johnson Medical School Internal Review Board (project no 0220055271).

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