Early brain and abdominal oxygenation in extremely low birth weight infants

Valerie Y Chock; Emily Smith; Sylvia Tan; M Bethany Ball; Abhik Das; Susan R Hintz; Haresh Kirpalani; Edward F Bell; Lina F Chalak; Waldemar A Carlo; C Michael Cotten; John A Widness; Kathleen A Kennedy; Robin K Ohls; Ruth B Seabrook; Ravi M Patel; Abbot R Laptook; Toni Mancini; Gregory M Sokol; Michele C Walsh; Bradley A Yoder; Brenda B Poindexter; Sanjay Chawla; Carl T D'Angio; Rosemary D Higgins; Krisa P Van Meurs; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1038/s41390-022-02082-z

Early brain and abdominal oxygenation in extremely low birth weight infants

Pediatr Res. 2022 Oct;92(4):1034-1041. doi: 10.1038/s41390-022-02082-z. Epub 2022 May 5.

Authors

Valerie Y Chock¹, Emily Smith², Sylvia Tan², M Bethany Ball³, Abhik Das⁴, Susan R Hintz³, Haresh Kirpalani⁵, Edward F Bell⁶, Lina F Chalak⁷, Waldemar A Carlo⁸, C Michael Cotten⁹, John A Widness⁶, Kathleen A Kennedy¹⁰, Robin K Ohls^{11

12}, Ruth B Seabrook¹³, Ravi M Patel¹⁴, Abbot R Laptook¹⁵, Toni Mancini⁵, Gregory M Sokol¹⁶, Michele C Walsh¹⁷, Bradley A Yoder¹², Brenda B Poindexter¹⁴, Sanjay Chawla¹⁸, Carl T D'Angio¹⁹, Rosemary D Higgins^{20

21}, Krisa P Van Meurs³; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Affiliations

¹ Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA. vchock@stanford.edu.
² Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, Rockville, NC, USA.
³ Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
⁴ Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA.
⁵ Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
⁷ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁸ Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹ Department of Pediatrics, Duke University, Durham, NC, USA.
¹⁰ Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
¹¹ University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
¹² Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹³ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
¹⁴ Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA.
¹⁵ Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA.
¹⁶ Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁷ Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
¹⁸ Department of Pediatrics, Wayne State University, Detroit, MI, USA.
¹⁹ University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
²⁰ Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
²¹ College of Health and Human Services, George Mason University, Fairfax, VA, USA.

Abstract

Background: Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined.

Methods: A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables.

Results: In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001).

Conclusion: Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population.

Impact: Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies. Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases. A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome. Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Birth Weight
Brain
Cerebrovascular Circulation
Female
Hemoglobins
Humans
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature*
Oxygen
Pregnancy
Prospective Studies

Substances

Oxygen
Hemoglobins

Abstract

Publication types

MeSH terms

Substances

Grants and funding