title: Simultaneous measurement of cerebral hemoglobin oxygen saturation and blood volume in asphyxiated neonates by near-infrared time-resolved spectroscopy.
abstract: BACKGROUND
  Hypoxic-ischemic encephalopathy (HIE) usually results in a poor clinical outcome even when treated with hypothermic therapy (HT). Early postnatal changes in cerebral blood oxygenation and hemodynamics may be critical determinants of brain injury and the efficacy of HT.
  
  
  OBJECTIVE
  We measured cerebral hemoglobin oxygen saturation (ScO2) and cerebral blood volume (CBV) by near-infrared time-resolved spectroscopy (TRS) in HT-treated and non-HT-treated neonatal HIE patients to assess the influence of these parameters on clinical outcome.
  
  
  METHODS
  We retrospectively compared ScO2, CBV, and clinical outcomes of 11 neonates with HIE: 5 were treated by HT (HT-treated; 33.5°C±0.5°C for 72h starting approximately 6h after delivery) and 6 were not (non-HT-treated). Both CBV and ScO2 were measured by TRS at 6, 24, 48, and 72h after birth. Magnetic resonance imaging (MRI) was performed 1-2weeks after birth to assess brain injury.
  
  
  RESULTS
  Five neonates had adverse outcomes (3 HT-treated, 2 non-HT-treated). Of these, 1 died within 3days of birth and 4 had abnormal MRI findings, including basal ganglia, white matter, and/or thalamic lesions. The other 6 neonates had normal MRI findings (favorable outcome). At 6h after birth, CBV was significantly higher in neonates with adverse outcomes compared with those with a favorable outcome. At 24h after birth, ScO2 was significantly higher in neonates with adverse outcomes. Furthermore, we found that combined CBV at 24h after birth plus ScO2 had the best predictive ability for neurological outcome: sensitivity, specificity, positive predictive value, and negative predictive value were all 100%.
  
  
  CONCLUSIONS
  Early postnatal CBV and ScO2 elevations were predictive of a poor outcome in HIE. Therefore, measuring combined CBV plus ScO2 at 24h after birth can allow more precise prediction of neurological outcome. Control of postnatal CBV and ScO2 is critical for effective HIE treatment.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Koyano
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Jinnai
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamano
authors.affiliation: Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Saneyuki
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Konishi
authors.affiliation: Department of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kuboi
authors.affiliation: Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kanenishi
authors.affiliation: Department of Education for Children with Special Needs, Faculty of Education, Kagawa University, Kagawa, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan. Electronic address: kusaka@med.kagawa-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kusaka
mesh_terms: D001237:Asphyxia / Q000097:blood*; D001810:Blood Volume; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D020925:Hypoxia-Ischemia, Brain / Q000097:blood* / Q000473:pathology / Q000628:therapy; D000068104:Infant Health; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010100:Oxygen / Q000097:blood*; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D010100:Oxygen
keywords: Cerebral blood volume; Cerebral hemoglobin oxygen saturation; Hypothermic therapy; Hypoxia-ischemic encephalopathy; Near-infrared time-resolved spectroscopy