Abstract
Measurements of cerebral oxygen consumption (CVo2) may improve our understanding of cerebral oxygenation, but there are few published data for sick neonates. Although cerebral maturation is associated with an increase in cerebral glucose consumption, the relationship between CVo2 and increasing gestational age has not previously been assessed in humans. The aims of this study were to evaluate a noninvasive method for the estimation of CVo2 in the neonate using near infrared spectroscopy, and to investigate the relationship between gestational age and CVo2. Twenty babies who were undergoing intensive care in the neonatal period were studied. Cerebral hemoglobin flow (CHbF) and cerebral venous oxyhemoglobin saturation (CSvo2) were measured using near infrared spectroscopy. Arterial oxyhemoglobin saturation was measure by pulse oximetry (Spo2). CVo2 was calculated from the equation: CVo2 = CHbF ×(Spo2 - Svo2 × 4. The median (range) CVo2 was 0.9(0.52-1.76) mL·100 g-1 min-1. There was an increase in CVo2 with advancing gestational age (n = 20, ρ = 0.55,p = 0.014). We conclude that CVo2 can be estimated in sick neonates using noninvasive optical methods. The values obtained are similar to those obtained in other studies by more invasive methods, and are in agreement with values which would be expected from the known rate of cerebral glucose consumption in neonates. Mean (SD) CVo2 at 24-26 wk was 0.5 (0.18) mL·100 g-1 min-1 and rose with increasing gestation to term by 0.03 mL·100 g-1 min-1 per wk.
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Abbreviations
- Cao 2 :
-
arterial oxygen content
- CBF :
-
cerebral blood flow
- CDo 2 :
-
cerebral oxygen delivery
- CHbF :
-
cerebral hemoglobin flow
- CSvo 2 :
-
cerebral venous oxyhemoglobin saturation
- Cvo 2 :
-
venous oxygen content
- CVo 2 :
-
cerebral oxygen consumptiony
- Hb :
-
deoxyhemoglobin
- Hbo 2 :
-
oxyhemoglobin
- [Hb] :
-
hemoglobin concentration in the blood
- NIRS :
-
near infrared spectroscopy
- Sao 2 :
-
arterial oxyhemoglobin saturation
- So 2 :
-
oxyhemoglobin saturation
- Spo 2 :
-
arterial oxyhemoglobin saturation by pulse oximetry
- Svo 2 :
-
venous oxyhemoglobin saturation
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APPENDIX
APPENDIX
CDO2 and CVO2 can be calculated from the standard equation Equation A1, Equation A2 where CDO2 is milliliters of O2·100 g of brain-1 min-1, CBF is milliliters of blood·100 g of brain-1 min-1), CaO2 is milliliters of O2/mL of blood, CVO2 is milliliters of O2·100 g of brain-1 min-1, and CvO2 is milliliters of O2/mL of blood.
The oxygen content of blood (milliliters of O2/mL of blood) can be calculated from: Equation A3 or, Equation A4 where [Hb] = grams/mL, SO2 = percentage HbO2 saturation, 1.39 = the stoichiometric value of oxygen for hemoglobin (milliliters/g), PO2 = partial pressure of O2 (mm Hg), and 0.00003 = coefficient of oxygen solubility(milliliters of O2/mL of blood).
Within the range of hemoglobin concentrations seen in neonates, at physiologic oxygen tensions approximately 99% of the oxygen in the blood is carried bound to hemoglobin. Dissolved oxygen can therefore be reasonably disregarded in the calculation of blood oxygen content. Blood oxygen content can therefore be calculated from: Equation A5 CDO2 and CVO2 can then be calculated by rearrangingEquations A1, A2, and A5Equation A6, Equation A7 where CHbF is grams of hemoglobin·100 g of brain-1 min-1, SaO2 and CSvO2 are percent.
Because each molecule of hemoglobin binds 4 molecules of O2, if the concentration of hemoglobin in blood is expressed in micromoles/mL, the blood oxygen content can be calculated in micromoles/mL using a modification of Equation A5: Equation A8 CDO2 and CVO2 can then be calculated in micromoles·100 g-1 min-1 from:Equation A9, Equation A10
To express CVO2 in milliliters of O2·100 mL of brain-1 min-1, the CHbF value was converted to grams·100 mL-1 min-1 from:Equation A11 where 64 500 = molecular weight of hemoglobin (grams/mol).
CVO2 and CDO2 were then recalculated in milliliters/100 g/min using Equations A6 and A7.
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Yoxall, C., Weindling, A. Measurement of Cerebral Oxygen Consumption in the Human Neonate Using Near Infrared Spectroscopy: Cerebral Oxygen Consumption Increases with Advancing Gestational Age. Pediatr Res 44, 283–290 (1998). https://doi.org/10.1203/00006450-199809000-00004
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DOI: https://doi.org/10.1203/00006450-199809000-00004
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