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Selected Publication:
Mattersberger, C.
The impact of glucose and the acid-base metabolism on the cerebral oxygenation of preterm and term neonates during the immediate transition after birth
- an observational study
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2021. pp. 91
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- Authors Med Uni Graz:
- Advisor:
- Cvirn Gerhard
- Pichler Gerhard
- Urlesberger Berndt
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- Abstract:
- 2.1Objective The cerebral autoregulation mechanism regulates the cerebral blood supply which depends on the oxygen demand of the brain. Its mechanisms and determining factors are currently not completely understood. Cardiovascular and respiratory components are still already known. Various studies on neonates reported that the blood-glucose-level (GLU) can have an impact on cerebral blood flow and subsequently on the cerebral oxygenation [cerebral-regional-Oxygen-Saturation (crSO2) and cerebral Fractional-Tissue-Oxygen-Extraction (FTOE)]. Further, current studies demonstrate that components of the acid-base-metabolism [lactate (LAC), pH-value (pH), base-excess (BE), and bicarbonate (BIC)] can also have an impact on the cerebral oxygenation in neonates. This dissertation aims at investigating potential associations between measured blood-glucose and parameters of the acid-base-metabolism and the cerebral oxygenation in preterm and term neonates during the immediate transition after birth. 2.2Methods A prospective observational study was performed and secondary outcome parameters were analyzed in the present study. Preterm and term neonates born by Cesarean section were included, for whom i) cerebral near-infrared-spectroscopy (NIRS) measurements were performed at the 15th minute after birth and ii) capillary measured blood-glucose and parameters of the acid-base-metabolism were taken between the 10th and 20th minute after birth. Routine monitoring was performed with pulse-oximetry [arterial-oxygen-saturation (SpO2) and heart rate (HR)]. Correlation analyses were performed to investigate potential associations between the measured blood-glucose and parameters of the acid-base-metabolism and the cerebral oxygenation. 2.3Results Results: Out of 224 eligible neonates, who were included in the prospective observational study, 36 preterm neonates [Gestational age: 34.1 weeks (29.8-36.7), Birth weight: 1935g (1054-3006)] and 116 term neonates [Gestational age: 38.9 weeks (37.0-41.4), Birth weight: 3235 g (2090-4466)] fulfilled the inclusion criteria. Median crSO2 values at 15 minutes after birth were 83% (45-95) in preterm neonates and 83% (54-95) in term neonates. Median FTOE values at 15 minutes after birth were 0.11 (0.01-0.47) in preterm neonates and 0.13 (0.01-0.41) in term neonates. In preterm neonates, higher GLU and LAC values and lower pH values were associated with lower crSO2 and higher FTOE. BIC was significantly positively associated with crSO2. Only GLU was significantly negatively associated with the crSO2, and BIC was significantly positively associated with the FTOE in term neonates. 2.4Conclusion There are associations between the blood-glucose and the parameters of the acid-base metabolism and cerebral oxygenation in preterm and term neonates, but there associations are more pronounced in preterm neonates.