Abstract
Cerebral blood flow (CBF) measurement by near infrared spectroscopy (NIRS) using oxyhemoglobin (Hbo2) as a tracer (CBF-Hbo2) needs rapid changes in arterial oxygen saturation (Sao2) which often cannot be achieved in many sick infants. An alternative method based on the same adaptation of the Fick principle using i.v. injection of the dye indocyanine green (ICG) is described (CBF-ICG). Six mechanically ventilated infants (age 26-38 wk, birth weight 0.885-3.730 kg) requiring supplementary oxygen therapy were studied within 72 h of birth. For CBF-ICG measurements, ICG (0.1 mg·kg-1 was injected via an umbilical venous catheter, and blood ICG concentration was measured by an optical umbilical artery catheter and brain ICG concentration was measured by NIRS. For CBF-HbO2 measurements the inspired oxygen concentration was rapidly increased, blood Hbo2 concentration was calculated from Sao2 measured by pulse oximetry, and brain Hbo2 concentration was measured by NIRS. A series of CBF measurements were performed using each method before and after altering the arterial carbon dioxide tension (Paco2). Mean CBF values from repeated measurements by each method at any given Paco2 were used to compare the methods. The SD of single measurements within an individual subject by CBF-ICG was 15%, and by CBF-HbO2, 24%. The relationship between the methods was mean CBF-ICG = (1.13. mean CBF-HbO2) - 2.76 mL·100 g-1·min-1 Hbo2 (r = 0.93, p< 0.001). The mean difference between the methods (CBF-ICG - CBF-Hbo2) was -0.25 mL·100 g-1·min-1 (95% confidence interval 6.30 to -6.80). The methods were in good agreement, and the use of i.v. ICG permitted rapid and repeated CBF measurements in the sickest infants at greatest risk of cerebral injury.
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Abbreviations
- CBF:
-
cerebral blood flow
- Hb:
-
deoxyhemoglobin
- Hbo2:
-
oxyhemoglobin
- ICG:
-
indocyanine green
- CBF-ICG:
-
CBF measured using ICG
- CBF-Hbo2:
-
CBF measured using Hbo2
- CI:
-
confidence interval
- NIRS:
-
near infrared spectroscopy
- Paco2:
-
arterial carbon dioxide tension
- Sao2:
-
arterial oxygen saturation
References
Pape KE, Wigglesworth JS 1979 Haemorrhage, Ischaemia and the Perinatal Brain. Heinemann, London, pp 100–133
Volpe JJ, ed 1994 Hypoxic-ischemic encephalopathy: neuropathology and pathogenesis. In: Neurology of the Newborn. WB Saunders, Philadelphia, pp 279–313
Volpe JJ, ed 1994 Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage. In: Neurology of the Newborn. WB Saunders, Philadelphia, pp 403–463
Skov L, Pryds O, Greisen G 1991 Estimating cerebral blood flow in newborn infants: comparison of near infrared spectroscopy and133 xenon clearance. Pediatr Res 30: 570–573
Volpe JJ, Herscovitch P, Perlman JM, Raichle ME 1983 Positron emission tomography in the newborn: extensive impairment of regional cerebral blood flow with intraventricular hemorrhage and hemorrhagic intracerebral involvement. Pediatrics 72: 589–601
Edwards AD, Wyatt JS, Richardson C, Delpy DT, Cope M, Reynolds EOR 1988 Cotside measurement of cerebral blood flow in ill newborn infants by near infrared spectroscopy. Lancet 2: 770–771
Bucher HU, Edwards AD, Lipp AE, Duc G 1993 Comparison between near infrared spectroscopy and 133xenon clearance for estimation of cerebral blood flow in critically ill preterm infants. Pediatr Res 33: 56–60
Niggemann EH, Ma PT, Sunnergreen KP, Winniford MD, Hillis LD 1987 Detection of intracardiac left-to-right shunting in adults: a prospective analysis of the variability of the standard indocyanine green technique in patients without shunting. Am J Cardiol 60: 355–357
Anderson PA, Bowyer KW, Jones RH 1984 Effects of age on radionuclide angiographic detection and quantitation of left-to-right shunts. Am J Cardiol 53: 879–883
Wyatt JS, Cope M, Delpy DT, van der Zee P, Arridge SR, Edwards AD, Reynolds EOR 1990 Measurement of optical pathlength for cerebral near infrared spectroscopy in newborn infants. Dev Neurosci 12: 140–144
Bland JM, Altman DG 1986 Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1: 307–310
Arnot RN, Glass HI, Clark JC 1970 Methods of measurement of cerebral blood flow in the newborn infant using cyclotron-produced isotopes. Radioaktive Isotope in Klinik und Forcshung 9: 60–74
Siesjo BK 1978 Brain Energy Metabolism. Wiley, Chichester, pp 422–426
Kogure K, Scheinberg P, Reinmuth OM, Fujishima M, Busto R 1970 Mechanism of cerebral vasodilatation in hypoxia. J Appl Physiol 29: 223–229
Roberts I, Fallon P, Kirkham FJ, Lloyd-Thomas A, Cooper C, Maynard R, Elliot M, Edwards AD 1993 Estimation of cerebral blood flow with near infrared spectroscopy and indocyanine green. Lancet 342: 1425
Colacino JM, Grubb B, Jobsis FF 1981 Infra-red method for cerebral blood flow: comparison with 133Xenon clearance. Neurol Res 3: 17–31
Wyatt JS, Cope M, Delpy DT, Richardson C, Edwards AD, Wray SC, Reynolds EOR 1990 Quantitation of cerebral blood volume in newborn infants by near infrared spectroscopy. J Appl Physiol 68: 1086–1091
Anthony MY, Goodall SR, Papouli M, Levene MI 1992 Measurement of plasma volume in neonates. Arch Dis Child 67: 36–40
Acknowledgements
The authors thank the staff of the Neonatal Units at Hammersmith Hospital and Queen Charlotte's and Chelsea Hospital, Dr. C. Cooper for providing the absorption coefficients for ICG, Dr. O. Pryds for statistical advice. We also thank Hammamatsu Photonics and Pulsion Medizintechnik.
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Supported by the British Heart Foundation (J.P., I.R.).
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Patel, J., Marks, K., Roberts, I. et al. Measurement of Cerebral Blood Flow in Newborn Infants Using Near Infrared Spectroscopy with Indocyanine Green. Pediatr Res 43, 34–39 (1998). https://doi.org/10.1203/00006450-199801000-00006
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DOI: https://doi.org/10.1203/00006450-199801000-00006
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