title: Use of renal near-infrared spectroscopy measurements in congenital diaphragmatic hernia patients on ECMO.
abstract: BACKGROUND
  This study tests the hypothesis that renal tissue oxygen saturation as measured by Near Infrared Spectroscopy (NIRS) would correlate with urine output in neonates with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Between 2012 and 2015, neonates with CDH were enrolled as part of a comprehensive study that provided renal/cerebral/abdominal NIRS monitoring for the duration of ECMO support. Continuous NIRS measurements, mean arterial pressure, and urine output were recorded. Periods of anuria (NU), adequate urine output >1ml/kg/h (AU), and low urine output <1ml/kg/h (LU) were noted and analyzed.
  
  
  RESULTS
  Over 1500h of continuous renal NIRS were obtained from six neonates. NIRS values were significantly different during periods of AU, LU, and anuria (84±6%, 76±3%, and 67±6%, p<0.01). ROC curves identified NIRS >76% as highly predictive of adequate urine output (AUC=0.96). MAP was significantly lower only in anuric patients, 36.42±10.26, compared to patients with AU and LU - 42.99±5.25 and 42.85±7.4, respectively (p<0.001).
  
  
  CONCLUSIONS
  Renal NIRS measurements correlate with urine production. Lower values are noted as urine output declines and precedes a decline in MAP. Renal NIRS may have promise as a non-invasive means of determining adequacy of renal perfusion and urine output in neonates with complex fluid shifts.
  
  
  METHODS
  IIb.
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Patricio E
authors.initials: PE
authors.lastname: Lau
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cruz
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Joseph
authors.initials: J
authors.lastname: Garcia-Prats
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Milenka
authors.initials: M
authors.lastname: Cuevas
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rhee
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Horne
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: oolutoye@bcm.edu.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
mesh_terms: D001002:Anuria / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000378:metabolism / Q000628:therapy* / Q000652:urine; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D012372:ROC Curve; D012189:Retrospective Studies; D016037:Single-Blind Method; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: CDH; ECMO; NIRS; Near infrared spectroscopy