Umbilical Arterial Blood Sampling Alters Cerebral Tissue Oxygenation in Very Low Birth Weight Neonates.
OBJECTIVE
To evaluate the magnitude, consistency, and natural history of reductions in cerebral regional tissue oxygenation (CrSO2) during umbilical arterial (UA) blood sampling in very low birth weight neonates.


METHODS
Data were collected during a prospective observational near-infrared spectroscopy survey conducted on a convenience sample of 500-1250 g neonates during the first 10 postnatal days. A before-after analysis of UA blood sampling effects on CrSO2 absolute values and variability was performed. The present analysis was not designed a priori and was conducted following the bedside observation of CrSO2 decrements contiguous with UA blood draws.


RESULTS
Fifteen very low birth weight neonates had 201 UA blood draws. Baseline CrSO2 (mean ± SEM) decreased following UA blood sampling, from 70 ± 1% to a nadir of 63 ± 1% (P < .001) occurring 4 ± 3 (range 2-24) minutes following blood draws. CrSO2 subsequently increased to 70 ± 1% (P < .001 compared with nadir) at 10 ± 4 (range 4-28) minutes following UA blood sampling. Coefficients of variation (mean ± SEM) increased from 0.02 ± 0.001 at baseline to 0.05 ± 0.004 (P < .001), followed by a decrease to 0.03 ± 0.003 (P < .001 for all comparisons), thus denoting increased CrSO2 variability following UA blood sampling.


CONCLUSIONS
UA blood sampling is associated with significant CrSO2 decrements with increased variability over clinically significant intervals. Whether these changes impact complications of prematurity, including intraventricular hemorrhage and periventricular leukomalacia, remain unknown.
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY. Electronic address: jonathan.mintzer@stonybrookmedicine.edu.
Jonathan P
JP
Mintzer
Division of Newborn Medicine, Department of Pediatrics, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY.
Boriana
B
Parvez
Division of Newborn Medicine, Department of Pediatrics, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY.
Edmund F
EF
La Gamma
D001800:Blood Specimen Collection / Q000379:methods*; D001921:Brain / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D014469:Umbilical Arteries / Q000473:pathology*
D010100:Oxygen