title: Near-infrared spectroscopy in the detection of regional tissue oxygenation during hypoxic events in preterm infants undergoing critical care.
abstract: OBJECTIVE
  To determine whether pulse oximetry-detected episodes of desaturation are associated with impairment of cerebral and somatic (renal) tissue oxygenation in mechanically ventilated preterm neonates.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  Neonatal intensive care unit of a university-affiliated children's hospital.
  
  
  METHODS
  Ten mechanically ventilated preterm (gestational age 24-32 wks) infants.
  
  
  METHODS
  In addition to the traditional monitoring of hemodynamic variables that included pulse oximetry (Sao2), near-infrared spectroscopy (NIRS) was used to evaluate the cerebral and somatic (renal) tissue oxygen saturation (rSO2C and rSO2R, respectively).
  
  
  RESULTS
  A total of 40 rSO2C and rSO2R measurements were simultaneously recorded: 20 during hypoxic events when the Sao2 was </=80% for >/=4 secs (cases) and generally ranged between 70% and 80%, and 20 measurements when the Sao2 was >/=85% (paired controls). Additionally, the fractional oxygen extraction (FOE) from the cerebral (FOEC) and renal (FOER) tissue was calculated. All the measurements were made under steady conditions during a 2-hr period. The rSO2C, rSO2R, FOEC, and FOER among the cases (Sao2 </= 80%) and controls (Sao2 >/= 85%) were compared using the paired Student's t-test. Both rSO2C and rSO2R during the desaturation episodes were lower than in the controls (51.6 +/- 6.3% vs. 66.2 +/- 10.2%, p < .0001 and 61.1 +/- 6.8% vs. 80.1 +/- 10.0%, p < .0001, respectively). The FOEC during the hypoxic episodes was comparable with control levels but increased in renal tissue. However, during two of the desaturation episodes (10%), the rSO2C and FOEC levels (which were <44% and >0.47, respectively) may reflect compromised tissue oxygen supply.
  
  
  CONCLUSIONS
  In the majority of mechanically ventilated preterm neonates, the reduction in cerebral and renal tissue oxygenation associated with short periods of decreased arterial saturation to 70-80% does not significantly compromise oxygen utilization in the cerebral tissue but increases oxygen extraction in the renal tissue, which might cause ischemic tissue injury following a further reduction in oxygen delivery.
authors.affiliation: Division of Neonatology, Department of Pediatrics, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Petrova
authors.forename: Rajeev
authors.initials: R
authors.lastname: Mehta
mesh_terms: D001921:Brain / Q000378:metabolism*; D003430:Cross-Sectional Studies; D006801:Humans; D000860:Hypoxia / Q000378:metabolism* / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000378:metabolism* / Q000628:therapy; D007363:Intensive Care Units, Neonatal; D007511:Ischemia / Q000517:prevention & control; D007668:Kidney / Q000378:metabolism*; D010092:Oximetry; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen