Cerebral and peripheral muscle oxygenation and perfusion: Course in moderate and late preterm neonates during the first day after birth.

AIM: To investigate the ratio of cerebral tissue oxygenation index (cTOI) to peripheral muscle tissue oxygenation index (pTOI) measured by near-infrared spectroscopy (NIRS) in cardio-circulatory stable preterm neonates without signs of inflammation/infection on the first day after birth. METHODS: Observational study analysing secondary outcome parameters of the 'Avoiding Hypotension in Preterm Neonates (AHIP)' trial (ClinicalTrials.gov identifier: NCT01910467). Preterm neonates, who had cTOI and pTOI measurements during 24 h after birth, were included. In each neonate the mean of the cTOI/pTOI-ratio, cTOI, pTOI and routine monitoring parameters were calculated for each hour and for the 24-h measuring period. Courses of all measured parameters were analysed. RESULTS: Eighty-seven stable preterm neonates (33.1 [32.1-34.1] weeks of gestation) were included. The mean value over the 24-h measuring period for the cTOI/pTOI-ratio was 0.96 ± 0.02, for cTOI 70.1 ± 1.4 and for pTOI 73.4 ± 0.9. Routine monitoring parameters were in the normal ranges over 24 h. The courses of the cTOI/pTOI-ratio and cTOI showed significantly lower values from hour 5 to 15 compared to the first hours after birth. Heart rate decreased significantly over time, whereas mean arterial blood pressure increased significantly. pTOI, arterial oxygen saturation and body temperature showed no significant change over time. CONCLUSION: We are the first to report on cTOI/pTOI-ratios for cardio-circulatory stable preterm neonates over a 24-h period after birth, showing significantly lower values from hour 5 to 15 compared to the first hours after birth.

[A new German Scale for Assessing Parental Stress after Preterm Birth (PSS:NICU_German/2-scales)]. / Eine neue deutschsprachige Skala zur Erfassung von elterlichem Stress nach Frühgeburtlichkeit (PSS:NICU_German/2-scales).

Background Preterm birth is known to be a stressful and anxious situation for parents, which might have long-term impact on the psychological health of mothers and even on the development of their preterm infants. Objective The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) was developed to assess parental stress after preterm birth through three subscales [1]. The aim of the present study was to examine the psychometric properties and the dimensionality of the German version of the PSS:NICU to develop a reliable German version of the PSS:NICU. Methods For the development (exploratory factor analysis) 100 parents of preterm infants answered the questionnaire. Results The Sights and Sounds subscale was removed from the German version of the PSS:NICU due to low number of items. A PSS: NICU_German/2-scales was developed consisting of 2 subscales: Infant Behavior and Appearance (7 Items, Cronbach's α=0,82) and Parental Role Alteration (6 Items, Cronbach's α=0,87). Conclusions The PSS:NICU_German/2-scales is a reliable and economic scale for the assessment of parental stress after preterm birth.

Lung-protective ventilatory strategies in intubated preterm neonates with RDS.

This article provides a narrative review of lung-protective ventilatory strategies (LPVS) in intubated preterm infants with RDS. A description of strategies is followed by results on short-and long-term respiratory and neurodevelopmental outcomes. Strategies will include patient-triggered or synchronized ventilation, volume targeted ventilation, the technique of intubation, surfactant administration and rapid extubation to NCPAP (INSURE), the open lung concept, strategies of high-frequency ventilation, and permissive hypercapnia. Based on this review single recommendations on optimal LPVS cannot be made. Combinations of several strategies, individually applied, most probably minimize or avoid potential serious respiratory and cerebral complications like bronchopulmonary dysplasia and cerebral palsy.

Oropharyngeal suctioning in neonates immediately after delivery: influence on cerebral and peripheral tissue oxygenation.

BACKGROUND: Routine oropharyngeal suctioning in term vigorous neonates immediately after birth is a questionable practice. Current recommendations favor suctioning only in the presence of considerable obstruction due to secretions, blood or other matter. We aimed to analyze the influence of oropharyngeal suctioning on cerebral and peripheral muscle oxygenation in term neonates during transition immediately after birth. METHODS: We included term neonates after elective cesarean section for this prospective observational study. Oropharyngeal suctioning was performed based on the clinicians' judgment of threatening airway obstruction. From a total of 138 enrolled neonates, 36 were suctioned and then compared to 36 controls matched for gestational age. Heart rate (HR) and pre/postductal arterial oxygen saturation (SpO2pre/SpO2post) were measured by pulse oximetry. Cerebral (rSO2brain) and pre/postductal peripheral muscle tissue oxygenation (rSO2pre/rSO2post) were measured by near infrared spectroscopy during the first 15min of life. RESULTS: All neonates in both groups experienced normal postnatal transition with normal Apgar scores (Apgar 9/10/10) and with no events of apnea or bradycardia induced by suctioning. SpO2pre values were slightly lower at 2 and 4min after birth. Suctioning had no main and interaction effect on HR, SpO2post, rSO2brain, rSO2pre and rSO2post in the first 15min after birth. CONCLUSION: In the present study we were able to show that, in term neonates, when correctly indicated, immediate postnatal oropharyngeal suctioning does not compromise cerebral and peripheral muscle tissue oxygenation. However, any suction maneuver must be performed with caution and strict indication during neonatal transition.

Feasibility of long-term cerebral and peripheral regional tissue oxygen saturation measurements.

The aim of this study was to analyse the feasibility of long-term measurements of cerebral (crSO2) and peripheral (prSO2) regional tissue oxygen saturation on the first day of life by determining the amount of artefacts and their influence on rSO2. Near infrared spectroscopy (NIRS) measurements were performed fronto-parietal left (crSO2) and on the right forearm (prSO2). Arterial oxygen saturation (SpO2) was measured by pulse oximetry on the right wrist. Three criteria (C) were defined to identify artefacts (C1: missing values, C2: rSO2 jumping >15%, C3: rSO2 ≥ SpO2). The number of artefacts as a percentage of measurement time and mean rSO2 was calculated after the introduction of each criterion. Measurements were performed in 40 neonates. The number of artefacts in crSO2 measurements was similar after introduction of C1 (7.37 ± 4.64%) and after introduction of all criteria (8.89 ± 4.59%). The number of artefacts in prSO2 measurements after introduction of C1 was 10.83 ± 4.21%, and after introduction of all criteria significantly higher with 17.78 ± 4.27%. After introduction of C1, further criteria did not significantly change rSO2: crSO2 (78.6 ± 1.3% versus 78.5 ± 1.2%) and prSO2 (83.7 ± 0.9% versus 83.5 ± 0.9%). In conclusion, long-term NIRS measurements of crSO2 and prSO2 are feasible, since most artefacts are due to missing values and therefore easy to recognize.