Abstract
Monitoring of cerebral oxygenation (rScO2) with near-infrared spectroscopy (NIRS) is a feasible noninvasive bedside technique in the NICU. This review discusses the possible neuroprotective role of “pattern recognition” of NIRS-derived rScO2 in preterm neonates with regard to the prevention of severe intraventricular hemorrhage and hypoxia/hyperoxia-related white matter injury. This neuroprotective role of rScO2 monitoring is discussed as a modality to aid in the early detection of cerebral oxygenation conditions predisposing to these complications. Practical guidelines are provided concerning management of abnormal rScO2 patterns as well as a brief discussion concerning the need for international consensus and the legal aspects associated with the introduction of a new NICU bedside monitoring strategy.
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06 August 2018
The original version of this article contained an error in the legend of Fig. 3, which incorrectly read:
Figure 3. a The patterns of arterial saturation (SaO2; orange), and rScO2 (blue) and mean arterial blood pressure (MABP; red) of an extremely preterm infant on postnatal day 1. The initial rScO2 values were very low (red box). These low values seemed to be associated with PaCO2 values below 30 mmHg (brown squares; starting at 24 mmHg. SaO2 and MABPs values were always normal. When PaCO2 values increased above values of 30 mmHg (brown arrow) the rScO2 increased and eventually normalized. b The patterns of rScO2 (blue) and mean arterial blood pressure (MABP; red) of a very preterm girl, starting on postnatal day 1, was especially marked by a steep decrease in cerebral oxygenation (rScO2; red box) to very low values (<40%). Echocardiographic investigation early on postnatal day 2 revealed a hemodynamically significant ductus arteriosus. Subsequent ductal closure with indomethacin (2 courses) was followed by normalization of cerebral oxygenation. c The patterns of heart rate (HR), arterial saturation (SaO2) and rScO2 (red box) in a preterm neonate.with severe anemia. The rather low rScO2 recovered following packed red blood cell transfusion (courtesy Prof. Gunnar Naulaers, UZ Leuven).
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Acknowledgements
The authors thank Dr. Petra Lemmers and Dr. Willem Baerts for their critical reading of the manuscript and advice. No financial assistance was received in support of the study.
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van Bel, F., Mintzer, J.P. Monitoring cerebral oxygenation of the immature brain: a neuroprotective strategy?. Pediatr Res 84, 159–164 (2018). https://doi.org/10.1038/s41390-018-0026-8
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DOI: https://doi.org/10.1038/s41390-018-0026-8
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