Simultaneous measurement of cerebral hemoglobin oxygen saturation and blood volume in asphyxiated neonates by near-infrared time-resolved spectroscopy

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. OBJECTIVES 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%. CONCLUSION 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.

[1]  David A Boas,et al.  Increased Cerebral Blood Volume and Oxygen Consumption in Neonatal Brain Injury , 2009, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[2]  L. D. de Vries,et al.  Effect of Hypothermia on Amplitude-Integrated Electroencephalogram in Infants With Asphyxia , 2010, Pediatrics.

[3]  Takashi Kusaka,et al.  Developmental Changes of Optical Properties in Neonates Determined by Near-Infrared Time-Resolved Spectroscopy , 2005, Pediatric Research.

[4]  Frank van Bel,et al.  Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their Relation to Outcome The authors have indicated they have no financial relationships relevant to this article to disclose. , 2006, Pediatrics.

[5]  J. Allsop,et al.  Magnetic resonance imaging in hypoxic-ischaemic encephalopathy. , 2010, Early human development.

[6]  Agnese Suppiej,et al.  Can tissue oxygenation index (TOI) and cotside neurophysiological variables predict outcome in depressed/asphyxiated newborn infants? , 2007, Early human development.

[7]  T. Kusaka,et al.  Relationship Between Cerebral Oxygenation and Phosphorylation Potential During Secondary Energy Failure in Hypoxic-Ischemic Newborn Piglets , 2009, Pediatric Research.

[8]  G. Faldella,et al.  Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study , 2013, Brain and Development.

[9]  D. Delpy,et al.  Quantitation of cerebral blood volume in human infants by near-infrared spectroscopy. , 1990, Journal of applied physiology.

[10]  M. Benders,et al.  Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value? , 2013, Pediatric Research.

[11]  J. W. Burns,et al.  Limited short-term prognostic utility of cerebral NIRS during neonatal therapeutic hypothermia , 2013, Neurology.

[12]  Esra Onal,et al.  Use of amplitude-integrated electroencephalography (aEEG) and near infrared spectroscopy findings in neonates with asphyxia during selective head cooling , 2012, Brain and Development.

[13]  Clare E Elwell,et al.  Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome , 1999, Archives of disease in childhood. Fetal and neonatal edition.

[14]  T. Koyama,et al.  Utility of the Kyoto Scale of Psychological Development in cognitive assessment of children with pervasive developmental disorders , 2009, Psychiatry and clinical neurosciences.

[15]  T. Kusaka,et al.  Cerebral metabolism and regional cerebral blood flow during moderate systemic cooling in newborn piglets , 2001, Pediatrics international : official journal of the Japan Pediatric Society.

[16]  Takashi Kusaka,et al.  The effect of blood transfusion on cerebral hemodynamics in preterm infants , 2013, Transfusion.

[17]  T. Kusaka,et al.  Cerebral blood volume combined with amplitude-integrated EEG can be a suitable guide to control hypoxic/ischemic insult in a piglet model , 2013, Brain and Development.

[18]  J. Perlman,et al.  Intervention strategies for neonatal hypoxic-ischemic cerebral injury. , 2006, Clinical therapeutics.

[19]  P. Grant,et al.  Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia , 2014, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[20]  P. Zeeuwe,et al.  Changes in cerebral hemodynamics and oxygenation during hypothermic cardiopulmonary bypass in neonates and infants. , 1996, Biology of the neonate.

[21]  T. Kusaka,et al.  Relationship between early changes in cerebral blood volume and electrocortical activity after hypoxic–ischemic insult in newborn piglets , 2014, Brain and Development.

[22]  P. Gluckman,et al.  Delayed Vasodilation and Altered Oxygenation after Cerebral Ischemia in Fetal Sheep , 1996, Pediatric Research.

[23]  Simon K. Warfield,et al.  Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic–ischemic encephalopathy treated with hypothermia , 2014, NeuroImage.

[24]  G. Jenkin,et al.  Nucleated red blood cell counts: An early predictor of brain injury and 2-year outcome in neonates with hypoxic–ischemic encephalopathy in the era of cooling-based treatment , 2014, Brain and Development.