title: Near infrared spectroscopy: experience on esophageal atresia infants.
abstract: OBJECTIVE
  Near infrared spectroscopy (NIRS) gradually became the gold standard to guide anesthetic conduction during cardiac surgery, and nowadays, it is commonly utilized to monitor cerebral oxygenation during invasive procedures. Preterm babies also benefit from this non-invasive monitoring to prevent neurological sequelae. However, few data are available on NIRS perioperative changes in newborn operated on for major non-cardiac malformations. Aim of the present study is to evaluate the usefulness of NIRS assessment during and after esophageal atresia (EA) correction and its correlation with clinical behavior.
  
  
  METHODS
  All patients treated for EA from May 2011 were prospectively enrolled in the study. All infants underwent "open" correction of EA and cerebral and splanchnic NIRS was applied up to 48h after surgery. Body temperature, blood pressure, pH, paSO2, paCO2, and urine output, were recorded during NIRS registration. Mann-Whitney test and 1-way ANOVA (Kruskal-Wallis and Dunn's multiple comparison tests) were used as appropriate.
  
  
  RESULTS
  Seventeen patients were enrolled into the study and 13 were available for the analysis. Four patients were excluded because of poor NIRS registration. Cerebral and renal NIRS values significantly decreased at 24h post-operatively (p<0.05). Interestingly, all parameters studied as possible confounders in NIRS remained stable during the study period. Urine output significantly decreased.
  
  
  CONCLUSIONS
  Our data confirmed that perioperative monitoring of tissue oxygenation during neonatal esophageal surgery is feasible. Cerebral and renal NIRS evaluation, as for cardiac patients, may guide anesthetic conduction and postoperative care. Out data suggest a newly observed hemodynamic reorganization during esophageal surgery involving renal and, probably, splanchnic blood flow redistribution, demonstrated by the observed subsequent significant post-operative transitory decrease in urinary output. Reducing the decrement in cerebral and renal NIRS values may improve, and ideally eliminate, the well-known late sequelae linked to hemodynamic changes during surgery. More studies are needed to better understand the causes of the NIRS described hemodynamic changes and, therefore, correct them.
authors: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: andrea.conforti@opbg.net.
authors: Andrea
authors: A
authors: Conforti
authors: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Paola
authors: P
authors: Giliberti
authors: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Vito
authors: V
authors: Mondi
authors: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Laura
authors: L
authors: Valfré
authors: Department of Anaesthesiology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Stefania
authors: S
authors: Sgro
authors: Department of Anaesthesiology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Sergio
authors: S
authors: Picardo
authors: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Pietro
authors: P
authors: Bagolan
authors: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Andrea
authors: A
authors: Dotta
mesh_terms: D001921:Brain / Q000378:metabolism*; D002245:Carbon Dioxide / Q000097:blood; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007430:Intraoperative Care; D007668:Kidney / Q000378:metabolism*; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010313:Partial Pressure; D010865:Pilot Projects; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: Esophageal atresia; Esophagus; Intraoperative monitoring; NIRS; Near infrared spectroscopy; Newborn