Low cerebral activity and cerebral oxygenation during immediate transition in term neonates—A prospective observational study

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• 作者：Anna Tamussino^a ; ^b ; Berndt Urlesberger^a ; ^b ; Nariae Baik^a ; ^b ; Bernhard Schwaberger^a ; ^b ; Corinna Binder-Heschl^a ; ^b ; Georg M. Schmö ; lzer^a ; ^c ; ^d ; Alexander Avian^e ; Gerhard Pichler^a ; ^b ; ^c ; ^d ; ^{gerhard.pichler@medunigraz.at" class="auth_mail" title="E-mail the corresponding author} ; ^{pichler.gerhard@klinikum-graz.at" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cerebral regional oxygen saturation ; Cerebral activity ; Transition ; Term neonate
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：103
• 期：Complete
• 页码：49-53
• 全文大小：454 K

文摘

To analyze whether in term neonates during immediate transition after birth low cerebral activity measured by amplitude-integrated EEG (aEEG) is linked to cerebral regional oxygen saturation (crSO₂) measured by near-infrared spectroscopy (NIRS). Additionally, the cerebral fractional tissue oxygen extraction (cFTOE) was calculated to analyze whether cerebral activity is linked to cFTOE.

Methods

A total of 244 term neonates delivered by primary cesarean section were studied. In addition to routine monitoring with pulse oximetry, aEEG and NIRS measurements were performed during the first 15 min after birth. The mean minimum (V_min) and maximum (V_max) amplitude of the cerebral activity as well as crSO₂ and cFTOE for each minute was determined. Neonates with initial V_min < 5 μV or V_max < 10 μV, which normalized during transition (study group) were compared to neonates with normal aEEG values throughout the whole monitoring period (control group).

Results

9 neonates fulfilled inclusion criteria to the study group and were compared to 50 neonates in the control group. V_min, V_max, crSO₂, SpO₂ and cFTOE were compared from the 4th to 15th min after birth. During our study period, V_min and V_max were significantly lower in the study group than in the control group. crSO₂ was significantly lower in the study group until minute 11, dropping below the 10th centile in minute 8. cFTOE was significantly higher in the study group until minute 10, rising above the 90th centile in minutes 8 and 9. SpO₂ was within normal ranges in both groups. crSO₂ and cFTOE were within normal ranges in the control group.

Conclusion

The present study demonstrates that neonates with initially low cerebral activity during immediate transition after birth concurrently showed low crSO₂ (<10th percentile), but increased cerebral oxygen extraction (cFTOE > 90th percentile). Cerebral monitoring with aEEG and NIRS might provide useful information on the neonates’ condition during immediate transition.