BACKGROUND: Definition of hemodynamically significant PDA (HS-PDA) is still controversial and its effects on cerebral and somatic tissue oxygenation (cSO2 and sSO2) as well as on fractional oxygen extraction (FOE) are not well known. OBJECTIVE: To use non invasive NIRS-technology in pretem infants ≤33 wks GA to evaluate differences in cSO2, postductal sSO2 and FOE according to the presence of PDA. DESIGN/METHODS: cSO2 and thoraco-lumbar sSO2 were measured simultaneously using the INVOS oximeter (Somanetics) in clinically stable preterm babies and the mean values, over a 10-min period, were expressed as CSOR (=sSO2/cSO2). Cerebral and somatic FOE (cFOE and sFOE) were calculated according to the formula=(SaO2-regionalSO2)/SaO2. The presence and the flow pattern through PDA were assessed by echocardiography.Unpaired t-test was used. RESULTS: 21 measurements were performed in 14 preterm infants (mean GA 29.6±3.9wks, BW 1230±460g, postnatal age 7.1±5.9 days). Mean CSOR was 1.101±0.127. No statistically significant differences were observed between babies with and without PDA for all parameters. Infants with pulsatile flow pattern at echocardiography (defined HS-PDA) showed an “inverted” CSOR<1 (mean value 0.874±0.076) mainly related to decrease in sSO2 while cSO2 was relatively spared. cFOE did not seem to be affected whereas a significant increase in sFOE was observed.[table1] CONCLUSIONS: Our results confirm previous studies¹ showing higher oxygenation of somatic compared with cerebral tissue in preterms and suggest that an “inverted” CSOR<1 might represent a sign of HS-PDA. NIRS technology could be routinely used as a trend monitor for cSO2 and sSO2 and might help in early detection of babies who would benefit from PDA closure. Due to the small sample size further studies are needed to confirm these data and adjust results for confounders. ¹Petrova A PediatrCritCareMed 2006
Near-Infrared Spectroscopy Measurement of Cerebro-Somatic Oxygenation Ratio (CSOR): May We Predict a Hemodynamically Significant Patent DuctusArteriosus (PDA)? / M. Fumagalli, M. Groppo, P. Fare, F. Schena, E. Ciarmoli, F.P. Dessimone, L. Ramenghi, F. Mosca. ((Intervento presentato al convegno Pediatric Academic Societies’ Annual Meeting tenutosi a Vancouver nel 2010.
Near-Infrared Spectroscopy Measurement of Cerebro-Somatic Oxygenation Ratio (CSOR): May We Predict a Hemodynamically Significant Patent DuctusArteriosus (PDA)?
M. Fumagalli;M. Groppo;E. Ciarmoli;F.P. Dessimone;F. Mosca
2010
Abstract
BACKGROUND: Definition of hemodynamically significant PDA (HS-PDA) is still controversial and its effects on cerebral and somatic tissue oxygenation (cSO2 and sSO2) as well as on fractional oxygen extraction (FOE) are not well known. OBJECTIVE: To use non invasive NIRS-technology in pretem infants ≤33 wks GA to evaluate differences in cSO2, postductal sSO2 and FOE according to the presence of PDA. DESIGN/METHODS: cSO2 and thoraco-lumbar sSO2 were measured simultaneously using the INVOS oximeter (Somanetics) in clinically stable preterm babies and the mean values, over a 10-min period, were expressed as CSOR (=sSO2/cSO2). Cerebral and somatic FOE (cFOE and sFOE) were calculated according to the formula=(SaO2-regionalSO2)/SaO2. The presence and the flow pattern through PDA were assessed by echocardiography.Unpaired t-test was used. RESULTS: 21 measurements were performed in 14 preterm infants (mean GA 29.6±3.9wks, BW 1230±460g, postnatal age 7.1±5.9 days). Mean CSOR was 1.101±0.127. No statistically significant differences were observed between babies with and without PDA for all parameters. Infants with pulsatile flow pattern at echocardiography (defined HS-PDA) showed an “inverted” CSOR<1 (mean value 0.874±0.076) mainly related to decrease in sSO2 while cSO2 was relatively spared. cFOE did not seem to be affected whereas a significant increase in sFOE was observed.[table1] CONCLUSIONS: Our results confirm previous studies¹ showing higher oxygenation of somatic compared with cerebral tissue in preterms and suggest that an “inverted” CSOR<1 might represent a sign of HS-PDA. NIRS technology could be routinely used as a trend monitor for cSO2 and sSO2 and might help in early detection of babies who would benefit from PDA closure. Due to the small sample size further studies are needed to confirm these data and adjust results for confounders. ¹Petrova A PediatrCritCareMed 2006
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