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Am J Perinatol 2015; 32(07): 645-652
DOI: 10.1055/s-0034-1390348
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Head Position Change Is Not Associated with Acute Changes in Bilateral Cerebral Oxygenation in Stable Preterm Infants during the First 3 Days of Life

Steve Ming-Che Liao
1   Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
,
Rakesh Rao
1   Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
,
Amit M. Mathur
1   Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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Publikationsverlauf

24. März 2014

28. Juli 2014

Publikationsdatum:
05. Oktober 2014 (online)

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Abstract

Objective Several recent intraventricular hemorrhage prevention bundles include midline head positioning to prevent potential disturbances in cerebral hemodynamics. We aimed to study the impact of head position change on regional cerebral saturations (SctO2) in preterm infants (< 30 weeks gestational age) during the first 3 days of life.

Study Design Bilateral SctO2 was measured by near-infrared spectroscopy. The infant's head was turned sequentially to each side from midline (baseline) in 30-minute intervals while keeping the body supine. Bilateral SctO2 before and after each position change were compared using paired t-test.

Results In relatively stable preterm infants (gestational age 26.5 ± 1.7 weeks, birth weight 930 ± 220 g; n = 20), bilateral SctO2 remained within normal range (71.1–75.3%) when the head was turned from midline position to either side.

Conclusion Stable preterm infants tolerated brief changes in head position from midline without significant alternation in bilateral SctO2; the impact on critically ill infants needs further evaluation.

Keywords

near-infrared spectroscopy - cerebral autoregulation - cerebral oxygenation - head positioning - premature infants
 

  • References

  • 1 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
    CrossrefPubMedGoogle Scholar
  • 2 Kadri H, Mawla AA, Kazah J. The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates. Childs Nerv Syst 2006; 22 (9) 1086-1090
    CrossrefPubMedGoogle Scholar
  • 3 Perlman JM. The relationship between systemic hemodynamic perturbations and periventricular-intraventricular hemorrhage—a historical perspective. Semin Pediatr Neurol 2009; 16 (4) 191-199
    CrossrefPubMedGoogle Scholar
  • 4 Wong FY, Leung TS, Austin T , et al. Impaired autoregulation in preterm infants identified by using spatially resolved spectroscopy. Pediatrics 2008; 121 (3) e604-e611
    CrossrefPubMedGoogle Scholar
  • 5 Noori S, McCoy M, Anderson MP, Ramji F, Seri I. Changes in cardiac function and cerebral blood flow in relation to peri/intraventricular hemorrhage in extremely preterm infants. J Pediatr 2014; 164 (2) 264-270 , e1–e3
    CrossrefPubMedGoogle Scholar
  • 6 Alderliesten T, Lemmers PM, Smarius JJ, van de Vosse RE, Baerts W, van Bel F. Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. J Pediatr 2013; 162 (4) 698-704
    CrossrefPubMedGoogle Scholar
  • 7 Bailey SM, Hendricks-Muñoz KD, Mally P. Splanchnic-cerebral oxygenation ratio as a marker of preterm infant blood transfusion needs. Transfusion 2012; 52 (2) 252-260
    CrossrefPubMedGoogle Scholar
  • 8 Chock VY, Ramamoorthy C, Van Meurs KP. Cerebral oxygenation during different treatment strategies for a patent ductus arteriosus. Neonatology 2011; 100 (3) 233-240
    CrossrefPubMedGoogle Scholar
  • 9 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) 415-419
    CrossrefPubMedGoogle Scholar
  • 10 Bhalla T, Dewhirst E, Sawardekar A, Dairo O, Tobias JD. Perioperative management of the pediatric patient with traumatic brain injury. Paediatr Anaesth 2012; 22 (7) 627-640
    CrossrefPubMedGoogle Scholar
  • 11 Cowan F, Thoresen M. Changes in superior sagittal sinus blood velocities due to postural alterations and pressure on the head of the newborn infant. Pediatrics 1985; 75 (6) 1038-1047
    PubMedGoogle Scholar
  • 12 Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics 2003; 112 (1, Pt 1) 33-39
    CrossrefPubMedGoogle Scholar
  • 13 Takashima S, Itoh M, Oka A. A history of our understanding of cerebral vascular development and pathogenesis of perinatal brain damage over the past 30 years. Semin Pediatr Neurol 2009; 16 (4) 226-236
    CrossrefPubMedGoogle Scholar
  • 14 Nankervis CA, Martin EM, Crane ML, Samson KS, Welty SE, Nelin LD. Implementation of a multidisciplinary guideline-driven approach to the care of the extremely premature infant improved hospital outcomes. Acta Paediatr 2010; 99 (2) 188-193
    PubMedGoogle Scholar
  • 15 Obladen M, Metze B, Henrich W, Aktas A, Czernik C, Schulz-Baldes A. Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g. Acta Paediatr 2008; 97 (6) 731-737
    CrossrefPubMedGoogle Scholar
  • 16 McLendon D, Check J, Carteaux P , et al. Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics 2003; 111 (4, Pt 2) e497-e503
    PubMedGoogle Scholar
  • 17 Pellicer A, Bravo Mdel C. Near-infrared spectroscopy: a methodology-focused review. Semin Fetal Neonatal Med 2011; 16 (1) 42-49
    CrossrefPubMedGoogle Scholar
  • 18 van Bel F, Lemmers P, Naulaers G. Monitoring neonatal regional cerebral oxygen saturation in clinical practice: value and pitfalls. Neonatology 2008; 94 (4) 237-244
    CrossrefPubMedGoogle Scholar
  • 19 Lloyd-Fox S, Blasi A, Elwell CE. Illuminating the developing brain: the past, present and future of functional near infrared spectroscopy. Neurosci Biobehav Rev 2010; 34 (3) 269-284
    CrossrefPubMedGoogle Scholar
  • 20 Roche-Labarbe N, Fenoglio A, Aggarwal A , et al. Near-infrared spectroscopy assessment of cerebral oxygen metabolism in the developing premature brain. J Cereb Blood Flow Metab 2012; 32 (3) 481-488
    CrossrefPubMedGoogle Scholar
  • 21 Wijbenga RG, Lemmers PM, van Bel F. Cerebral oxygenation during the first days of life in preterm and term neonates: differences between different brain regions. Pediatr Res 2011; 70 (4) 389-394
    PubMedGoogle Scholar
  • 22 Greisen G, Leung T, Wolf M. Has the time come to use near-infrared spectroscopy as a routine clinical tool in preterm infants undergoing intensive care?. Philos Trans A Math Phys Eng Sci 2011; 369 (1955) 4440-4451
    CrossrefPubMedGoogle Scholar
  • 23 Bembich S, Oretti C, Travan L, Clarici A, Massaccesi S, Demarini S. Effects of prone and supine position on cerebral blood flow in preterm infants. J Pediatr 2012; 160 (1) 162-164
    CrossrefPubMedGoogle Scholar
  • 24 Ancora G, Maranella E, Aceti A , et al. Effect of posture on brain hemodynamics in preterm newborns not mechanically ventilated. Neonatology 2010; 97 (3) 212-217
    Google Scholar
  • 25 Pellicer A, Gayá F, Madero R, Quero J, Cabañas F. Noninvasive continuous monitoring of the effects of head position on brain hemodynamics in ventilated infants. Pediatrics 2002; 109 (3) 434-440
    CrossrefPubMedGoogle Scholar
  • 26 Tax N, Pichler G, Grossauer K , et al. Tilting the head changes cerebral haemodynamics in neonates. Neonatology 2011; 100 (3) 253-259
    CrossrefPubMedGoogle Scholar
  • 27 Rais-Bahrami K, Rivera O, Short BL. Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter. J Perinatol 2006; 26 (10) 628-635
    CrossrefPubMedGoogle Scholar
  • 28 Malusky S, Donze A. Neutral head positioning in premature infants for intraventricular hemorrhage prevention: an evidence-based review. Neonatal Netw 2011; 30 (6) 381-396
    CrossrefPubMedGoogle Scholar
  • 29 Soul JS, Hammer PE, Tsuji M , et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr Res 2007; 61 (4) 467-473
    CrossrefPubMedGoogle Scholar
  • 30 Lemmers PM, van Bel F. Left-to-right differences of regional cerebral oxygen saturation and oxygen extraction in preterm infants during the first days of life. Pediatr Res 2009; 65 (2) 226-230
    CrossrefPubMedGoogle Scholar
  • 31 Monset-Couchard M, De Bethmann O, Brouard-Orzechowski C, Relier JP. Evaluation of peri-intraventricular hemorrhages in newborn infants taking into account laterality and parenchymal location. Application to 323 consecutive cases [in French]. J Radiol 1987; 68 (3) 159-166
    PubMedGoogle Scholar
  • 32 Jim WT, Chiu NC, Chen MR , et al. Cerebral hemodynamic change and intraventricular hemorrhage in very low birth weight infants with patent ductus arteriosus. Ultrasound Med Biol 2005; 31 (2) 197-202
    CrossrefPubMedGoogle Scholar
  • 33 Mullaart RA, Daniëls O, Hopman JC, de Haan AF, Stoelinga GB, Rotteveel JJ. Asymmetry of the cerebral blood flow: an ultrasound Doppler study in preterm newborns. Pediatr Neurol 1995; 13 (4) 319-322
    CrossrefPubMedGoogle Scholar