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Hoeller, N.
Relationship between cerebral and peripheral oxygenation and perfusion in preterm neonates: Changes in neonates with infection during the first day after birth.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2020. pp. 99 [OPEN ACCESS]


Authors Med Uni Graz:
Höller Nina
Cvirn Gerhard
Pichler Gerhard
Urlesberger Berndt

Introduction: Early recognition of cardio-circulatory signs of inflammation especially in case of sepsis is difficult in neonates. The aim of the present study was to evaluate cerebral and peripheral muscle oxygenation measured simultaneously with near-infrared spectroscopy (NIRS) on the first day after birth and to investigate, if the ratio of cerebral to peripheral muscle oxygenation is associated with inflammation / infection in preterm neonates. Study design: The present prospective observational study was part of the single centre randomized controlled trail ‘Avoiding Hypotension in Preterm Neonates (AHIP)’ performed at the Neonatal intensive care unit, Medical University of Graz, Austria. Preterm neonates <37 weeks of gestation with risk of infection due to premature rupture of membranes, maternal amnion infection syndrome and / or elevated maternal inflammation parameters were included into the study. Preterm neonates were divided into an infection (interleukin 6 >100pg/ml and / or leucocyte counts >34000/µl and / or C-reactive protein >10mg/l) and a healthy control group. In addition to routine monitoring (heart rate (HR), arterial oxygen saturation (SpO2) and mean arterial blood pressure (MAP)) continuous NIRS measurements (NIRO-200NX, Hamamatsu Photonics, Hamamatsu City, Japan) of cerebral (cTOI) and peripheral muscle tissue oxygenation index (pTOI) were performed simultaneously in each neonate over 24 hours starting within six hours after birth. To analyse possible differences between groups out of the continuous cTOI and pTOI measurements mean values of cTOI, pTOI and cTOI / pTOI ratio were calculated for every hour and compared between groups. Furthermore cTOI / pTOI ratios were correlated with demographic and routine monitoring parameters in both groups. Results: 98 preterm neonates were measured and included into the study. 11 neonates were included in the infection (median 32.3 [28.7-34.0] weeks of gestation) and 87 preterm neonates in the control group (median 33.1 [32.1-34.1] weeks of gestation; p=0.45). Mean value of cTOI / pTOI ratio of the 24-hours measuring period was 0.96 ± 0.02 vs. 0.97 ± 0.04 (control group vs. infection group; p=0.618), of cTOI 70.1 ± 1.4% vs. 71.2 ± 2.6% (p=0.079) and of pTOI 73.4 ± 0.9% vs. 73.6 ± 1.4% (p=0.564). cTOI / pTOI ratios as well as cTOI and pTOI values of each hour during the 24-hour measuring period showed no significant difference between the two groups. In the control group there was a significant positive correlation of cTOI / pTOI ratio and HR, whereas in the infection group no significant correlation was observed. Conclusion: In the present study preterm neonates with inflammation / infection showed no significant difference in cTOI / pTOI ratios compared to neonates without inflammation / infection on the first day after birth. Different behaviour of cTOI / pTOI ratios in regard to HR suggest differences in the interaction of macro-circulation (HR) and micro-circulation (cTOI / pTOI ratios) and therefore, cTOI / pTOI ratios might still be of interest in the diagnosis of early stages of cardio-circulatory disturbances in more severely sick neonates.

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