title: A novel multimodal computational system using near-infrared spectroscopy to monitor cerebral oxygenation during assisted ventilation in CDH patients.
abstract: OBJECTIVE
  The aim of this study was to create a computational simulator to serve as an early alert system for cerebral hypoxemia prior to the onset of clinical symptoms.
  
  
  METHODS
  Neonates with congenital diaphragmatic hernia (Jan 2010-Dec 2014) were recruited to collect continuous measurements of cerebral tissue oxygen saturation (cStO2) using a near-infrared spectroscopy (NIRS) device (FORE-SIGHT®, CASMED). Clinicians were blinded to NIRS data and treated infants based on pre-established clinical protocols. Charts were reviewed retrospectively to identify clinical events of hypoxemia (spontaneous, sustained decrease in preductal SpO2<85% leading to ventilator changes). We developed a computational algorithm that determined baseline values, variability and event data for each patient.
  
  
  RESULTS
  Twenty-three of 36 patients enrolled met data criteria. The algorithm anticipated an event at least 15 minutes prior to the event in 77% of cases, with an average pre-event detection of 47 minutes (range 16-122 minutes). Post-event StO2 (SpO2<85%) was determined to be 63.7% ± 11.7. In this computational model, the sensitivity to distinguish low states of cerebral perfusion was 94% with a specificity of 96%.
  
  
  CONCLUSIONS
  We have developed a computational algorithm with an early warning system that has the potential of being translated into a real-time clinical interface that may improve management of neonates.
authors.affiliation: Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Cruz
authors.affiliation: Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Adesola C
authors.initials: AC
authors.lastname: Akinkuotu
authors.affiliation: Department of Pediatrics-Cardiology Division, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rusin
authors.affiliation: Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Department of Pediatrics-Newborn Section, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.affiliation: Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States. Electronic address: oolutoye@bcm.edu.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
mesh_terms: D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D001921:Brain / Q000378:metabolism*; D003661:Decision Support Techniques; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D007231:Infant, Newborn; D064847:Multimodal Imaging; D064926:Neurophysiological Monitoring / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: CDH; Cerebral oxygenation; Near infrared spectroscopy