Critically ill neonates are subjected to severe and abrupt hemodynamic imbalances that could cause cerebral damage (e.g., hemorrhage, ischemic events). In this population, the need for cerebral monitoring tools to identify dangerous hemodynamic variations in real-time is paramount. Near-infrared spectroscopy (NIRS) is largely exploited in neonatal intensive care units (NICU) to monitor critically ill patients' cerebral oxygenation. However, the most used NIRS devices exploit continuous wave NIRS (CW NIRS) technique, which is affected by motion artifacts and has low penetration depth compared to other more complex NIRS techniques. Moreover, CW-NIRS does not allow the investigation of tissue perfusion. Thus, in this ongoing study, we tested a hybrid device that combines time-domain NIRS (TD-NIRS) and diffuse correlation spectroscopy (DCS) for monitoring absolute cerebral total hemoglobin concentration (tHb), cerebral tissue oxygen saturation (StO2), and cerebral blood flow index (BFI) of piglets during induced hemodynamic variations. Cerebral hemodynamic variations were induced during extracorporeal membrane oxygenation (ECMO) procedure, simulating four common conditions affecting the cerebral hemodynamics of ill neonates: hypocapnia, hypercapnia, hypotension, and hypertension. We measured 4 piglets, and the preliminary results shown in this study are promising, obtaining hemodynamic variations in accordance with previous findings, and empowering the possibility to exploit hybrid TD-NIRS and DCS devices to assess cerebral health of ill neonates.
Anemia is a common problem in preterm neonates, and red blood cell transfusion (RBCT) is used to improve oxygen delivery. In order to limit the risk of possible complications new strategies to minimize the need for RBCTs are needed, as assessment of hemoglobin concentration in blood ([Hb]) alone appears to be an inadequate biomarker. In this study, we search for hemodynamic and metabolic thresholds to help define the need of RBCT in anemic newborns. The effect of RBCTs on cerebral tissue oxygen saturation (StO2) and blood flow (measured as Blood Flow Index, BFI) was estimated using a non-invasive hybrid diffuse optical device that combines Time Domain NIRS (TD-NIRS) and Diffuse Correlation Spectroscopy (DCS) techniques (BabyLux device). We enrolled 18 clinically stable neonates receiving RBCT at Neonatal Intensive Care Unit (NICU) of Ospedale Maggiore Policlinico in Milan. Tissue oxygen extraction (TOE) and the cerebral metabolic rate of oxygen consumption index (CMRO2I) were computed, the Wilkinson signed rank test for paired data was performed to compare data before and after RBCT. Preliminary results are in accordance with previous publications as regards cerebral oxygenation: a significant increase in StO2 (from 56.62 ± 5.20% to 63.85 ± 4.95%, p<0.05) and reduction in TOE (from 41.35 ± 5.9 % to 31.04 ±5.41%, p<0.05) were observed. The response in cerebral blood flow was smaller (only 10%) but also more variable, so conclusions regarding the effect of transfusion on cerebral oxygen metabolism are still uncertain.
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