Near-Infrared Spectroscopy Monitoring, Superior Vena Cava Flow, and Neurodevelopmental Outcome at 2 years in a Cohort of Very Low-Birth-Weight Infants

Abstract

Objective We aimed at assessing the association between superior vena cava flow (SVCf), regional (cerebral) tissue oxygen saturation (rSO₂), and cerebral fractional oxygen extraction (CFOE) during the first 48 hours of life and 2-years neurodevelopmental outcome of very low-birth-weight infants (VLBW).

Methods We prospectively studied 60 VLBW infants admitted to our neonatal intensive care unit; rSO₂ was continuously monitored with near-infrared spectroscopy during the first 48 hours of life, SVCf was measured at 4 to 6, 12, 24, and 48 hours, and CFOE was calculated. Neurodevelopmental outcome was assessed at 24 months corrected age.

Results The mean gestational age at birth was 27.9 weeks (standard deviation: 2.4); 8 infants died in the first 3 months of life, 6 were lost to follow-up, 46 survived and were followed up. At 24 months, 6 (13%) and 7 (15.2%) infants developed minor and major sequelae, respectively. Infants who died had higher CFOE (p < 0.001) and lower SVCf (p < 0.001) than infants surviving with sequelae. In turn, these had higher SVCf between 24 and 48 hours than those without sequelae (p < 0.001).

Conclusion SVCf, rSO_2, and CFOE patterns in the first days of life suggest cerebral hyperperfusion, related to loss of autoregulation and/or use of inotropic drugs, as a potential mechanism of cerebral injury.

Keywords

preterm - superior vena cava flow - NIRS monitoring - neurodevelopmental outcome - inotropic drugs

• References

• 1 Noori S, Seri I. Hemodynamic antecedents of peri/intraventricular hemorrhage in very preterm neonates. Semin Fetal Neonatal Med 2015; 20 (04) 232-237
• 2 Kluckow M, Evans N. Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 2000; 82 (03) F182-F187
• 3 Cerbo RM, Scudeller L, Maragliano R. , et al. Cerebral Oxygenation, Superior Vena Cava Flow, Severe Intraventricular Hemorrhage and Mortality in 60 Very Low Birth Weight Infants. Neonatology 2015; 108 (04) 246-252
• 4 Toet MC, Lemmers PM, van Schelven LJ, van Bel F. Cerebral oxygenation and electrical activity after birth asphyxia: their relation to outcome. Pediatrics 2006; 117 (02) 333-339
• 5 Alderliesten T, Lemmers PM, van Haastert IC. , et al. Hypotension in preterm neonates: low blood pressure alone does not affect neurodevelopmental outcome. J Pediatr 2014; 164 (05) 986-991
• 6 Verhagen EA, Van Braeckel KN, van der Veere CN. , et al. Cerebral oxygenation is associated with neurodevelopmental outcome of preterm children at age 2 to 3 years. Dev Med Child Neurol 2015; 57 (05) 449-455
• 7 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 (04) 698-704.e2
• 8 Orcesi S, Olivieri I, Longo S. , et al. Neurodevelopmental outcome of preterm very low birth weight infants born from 2005 to 2007. Eur J Paediatr Neurol 2012; 16 (06) 716-723
• 9 Tak S, Ye JC. Statistical analysis of fNIRS data: a comprehensive review. Neuroimage 2014; 85 (Pt 1): 72-91
• 10 Alderliesten T, Dix L, Baerts W. , et al. Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates. Pediatr Res 2016; 79 (1–1): 55-64
• 11 Verhagen EA, Ter Horst HJ, Keating P, Martijn A, Van Braeckel KN, Bos AF. Cerebral oxygenation in preterm infants with germinal matrix-intraventricular hemorrhages. Stroke 2010; 41 (12) 2901-2907
• 12 Hyttel-Sorensen S, Pellicer A, Alderliesten T. , et al. Cerebral near infrared spectroscopy oximetry in extremely preterm infants: phase II randomised clinical trial. BMJ 2015; 350: g7635
• 13 Naulaers G, Meyns B, Miserez M. , et al. Use of tissue oxygenation index and fractional tissue oxygen extraction as non-invasive parameters for cerebral oxygenation. A validation study in piglets. Neonatology 2007; 92 (02) 120-126
• 14 O'Leary H, Gregas MC, Limperopoulos C. , et al. Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage. Pediatrics 2009; 124 (01) 302-309
• 15 Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 82 (03) F188-F194
• 16 Bravo MC, López-Ortego P, Sánchez L. , et al. Randomized, Placebo-Controlled Trial of Dobutamine for Low Superior Vena Cava Flow in Infants. J Pediatr 2015; 167 (03) 572-8.e1 , 2
• 17 Osborn DA, Evans N, Kluckow M. Left ventricular contractility in extremely premature infants in the first day and response to inotropes. Pediatr Res 2007; 61 (03) 335-340
• 18 Osborn DA, Evans N, Kluckow M, Bowen JR, Rieger I. Low superior vena cava flow and effect of inotropes on neurodevelopment to 3 years in preterm infants. Pediatrics 2007; 120 (02) 372-380