title: Slow blood sampling from an umbilical artery catheter prevents a decrease in cerebral oxygenation in the preterm newborn.
abstract: OBJECTIVE
  Blood sampling from an umbilical artery catheter (UAC) placed in a high position (thoracal 6-9) has the potential to produce clinically significant changes in cerebral blood flow and, thereby, in cerebral oxygenation. This may contribute to cerebral impairment in preterm newborn infants. Therefore, we set up a study to determine the effects of different sampling speeds through a UAC on cerebral oxygenation in preterm infants.
  
  
  METHODS
  Thirty pairs of measurements were conducted on 20 preterm infants (median gestational age: 30.14 weeks; median birth weight: 1170 g). For each infant, 2 blood samplings (both 2.3 mL, including flush volume) through the UAC in high position were taken at 2 different speeds (20 and 40 seconds) in alternating sequence. Cerebral oxygenation was measured noninvasively by near-infrared spectroscopy. Concentration changes in cerebral oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb), along with the tissue oxygenation index (TOI; O2Hb/[O2Hb + HHb] x 100), were recorded while blood was withdrawn and subsequently reinfused.
  
  
  RESULTS
  A significant decrease in O2Hb and TOI occurred during blood sampling within 20 seconds (median DeltaO2Hb: -1.5 micromol/L; range: -4.1-2.3; median DeltaTOI: -0.6%; range: -6.3-2.3), whereas HHb increased (median DeltaHHb: 0.4 micromol/L, range: -1.1-3.9). No significant change was found in O2Hb, HHb, and TOI when sampling time was extended to 40 seconds.
  
  
  CONCLUSIONS
  Our results show that blood withdrawal over 20 seconds from a UAC in high position significantly decreases cerebral O2Hb and TOI in preterm infants. Prolonging sampling time to 40 seconds can prevent this phenomenon.
authors.affiliation: Clinic of Neonatology, University Hospital, Zurich, Switzerland.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schulz
authors.forename: Esther
authors.initials: E
authors.lastname: Keller
authors.forename: Daniel
authors.initials: D
authors.lastname: Haensse
authors.forename: Romaine
authors.initials: R
authors.lastname: Arlettaz
authors.forename: Hans Ulrich
authors.initials: HU
authors.lastname: Bucher
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Fauchère
mesh_terms: D001800:Blood Specimen Collection / Q000379:methods*; D001810:Blood Volume / Q000502:physiology; D001921:Brain / Q000378:metabolism*; D002406:Catheterization, Peripheral; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000378:metabolism / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D010100:Oxygen / Q000378:metabolism*; D013997:Time Factors; D014469:Umbilical Arteries
chemical_list: D010100:Oxygen