Near-Infrared Spectroscopy Monitoring, Superior Vena Cava Flow, and Neurodevelopmental Outcome at 2 years in a Cohort of Very Low-Birth-Weight Infants.
Objective We aimed at assessing the association between superior vena cava flow (SVCf), regional (cerebral) tissue oxygen saturation (rSO2), and cerebral fractional oxygen extraction (CFOE) during the first 48 hours of life and 2-years neurodevelopmental outcome of very low-birth-weight infants (VLBW). Methods We prospectively studied 60 VLBW infants admitted to our neonatal intensive care unit; rSO2 was continuously monitored with near-infrared spectroscopy during the first 48 hours of life, SVCf was measured at 4 to 6, 12, 24, and 48 hours, and CFOE was calculated. Neurodevelopmental outcome was assessed at 24 months corrected age. Results The mean gestational age at birth was 27.9 weeks (standard deviation: 2.4); 8 infants died in the first 3 months of life, 6 were lost to follow-up, 46 survived and were followed up. At 24 months, 6 (13%) and 7 (15.2%) infants developed minor and major sequelae, respectively. Infants who died had higher CFOE (p < 0.001) and lower SVCf (p < 0.001) than infants surviving with sequelae. In turn, these had higher SVCf between 24 and 48 hours than those without sequelae (p < 0.001). Conclusion SVCf, rSO2, and CFOE patterns in the first days of life suggest cerebral hyperperfusion, related to loss of autoregulation and/or use of inotropic drugs, as a potential mechanism of cerebral injury.
Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Rosa Maria
RM
Cerbo
Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
Simona
S
Orcesi
Biostatistics and Clinical Epidemiology Unit, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy.
Luigia
L
Scudeller
Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Martina
M
Borellini
Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
Carolina
C
Croci
Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
Claudia
C
Ravelli
Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Giulia
G
Masa
Division of Neonatology and Neonatal Intensive Care, Casilino General Hospital, Roma, Italy.
Piermichele
P
Paolillo
Neonatology and Neonatal Intensive Care Unit, S. Anna Hospital, Turin, Italy.
Paolo
P
Manzoni
Child Neurology and Psychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
Umberto
U
Balottin
Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Mauro
M
Stronati
D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D007558:Italy; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D011446:Prospective Studies; D012044:Regression Analysis; D019265:Spectroscopy, Near-Infrared; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*
D010100:Oxygen