Clinical use of cerebral oximetry in extremely preterm infants is feasible

Simon Hyttel-Sørensen, Topun Austin, Frank van Bel, Manon Benders, Olivier Claris, Eugene M. Dempsey, Monica Fumagalli, Christian Gluud, Cornelia Hagmann, Lena Hellström-Westas, Petra Lemmers, Gunnar Naulaers, Wim van Oeveren, Adelina Pellicer, Gerhard Pichler, Claudia Roll, Lina Saem Støy, Martin Wolf, Gorm Greisen

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: The research programme Safeguarding the Brains of our smallest Children (SafeBoosC) aims to test the benefits and harms of cerebral near-infrared spectroscopy (NIRS) oximetry in infants born before 28 weeks of gestation. In a phase II trial, infants will be randomised to visible cerebral NIRS oximetry with pre-specified treatment guidelines compared to standard care with blinded NIRS-monitoring. The primary outcome is duration multiplied with the extent outside the normal range of regional tissue oxygen saturation of haemoglobin (rStO2) of 55 to 85% in percentage hours (burden). This study was a pilot of the Visible Oximetry Group. MATERIAL AND METHODS: This was an observational study including ten infants. RESULTS: The median gestational age was 26 weeks + three days, and the median start-up time was 133 minutes after delivery. The median recording time was 69.7 hours, mean rStO2 was 64.2 ± 4.5%, median burden of hyper- and hypoxia was 30.3% hours (range 2.8-112.3). Clinical staff responded to an out of range value 29 times - only once to values above 85%. In comparison, there were 83 periods of more than ten minutes with an rStO2 below 55% and four episodes with an rStO2 above 85%. These periods accounted for 72% of the total hypoxia burden. A total of 18 of the 29 interventions were adjustments of FiO2 which in 13 of the 18 times resulted in an out-of-range SpO2. Two infants suffered second-degree burns from the sensor. Five infants died. In all cases, this was unrelated to NIRS monitoring and treatment. CONCLUSION: The intervention of early cerebral NIRS monitoring proved feasible, but prolonged periods of hypoxia went untreated. Thus, a revision of the treatment guideline and an alarm system is required. FUNDING: The Elsass Foundation funded the present study. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01530360.

Original languageEnglish
JournalDanish Medical Journal
Volume60
Issue number1
Publication statusPublished - 2013

ASJC Scopus subject areas

  • Medicine(all)

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