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  • 1
    Language: English
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, 11 September 2015, Vol.100(5), p.F422
    Description: To investigate the occurrence of peri/intraventricular haemorrhage (P/IVH) in preterm infants and its potential association with cerebral regional oxygen saturation (crSO) during the immediate transition.
    Subject(s): Neonatology ; Brain Injury ; Preterm ; Regional Cerebral Oxygenation
    ISSN: 1359-2998
    ISSN: 13592998
    E-ISSN: 1468-2052
    E-ISSN: 14682052
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  • 2
    Language: English
    In: PloS one, 01 January 2015, Vol.10(9), p.e0138964
    Description: Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn't been investigated yet.Do SLI affect cerebral blood volume (CBV) in preterm infants?Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial. Within the first 15 minutes after birth near-infrared spectroscopy (NIRS) measurements using 'NIRO-200-NX' (Hamamatsu, Japan) were performed to evaluate changes in CBV and cerebral tissue oxygenation. Two groups were compared based on RS: In SLI group RS was given by applying 1-3 SLI (30 cmH2O for 15 s) continued by respiratory standard care. Control group received respiratory standard care only.40 infants (20 in each group) with mean gestational age of 32 weeks one day (±2 days) and birth weight of 1707 (±470) g were included....
    Subject(s): Sciences (General)
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: The Journal of pediatrics, March 2016, Vol.170, pp.73-78.e4
    Description: To assess if monitoring of cerebral regional tissue oxygen saturation (crSO2) using near-infrared spectroscopy (NIRS) to guide respiratory and supplemental oxygen support reduces burden of cerebral hypoxia and hyperoxia in preterm neonates during resuscitation after birth. Preterm neonates 34+0 weeks of gestation were included in a prospective randomized controlled pilot feasibility study at 2 tertiary level neonatal intensive care units. In a NIRS-visible group, crSO2 monitoring in addition to pulse oximetry was used to guide respiratory and supplemental oxygen support during the first 15 minutes after birth. In a NIRS-not-visible group, only pulse oximetry was used. The primary outcomes were burden of cerebral hypoxia (10th percentile) or hyperoxia (90th percentile) measured in %minutes crSO2 during the first 15 minutes after birth. Secondary outcomes were all cause of mortality and/or cerebral injury and neurologic outcome at term age. Allocation...
    Subject(s): %Minutes ; Crso2 ; Fio2 ; Ftoe ; Hr ; IVH ; NIRS ; Spo2 ; Medicine
    ISSN: 0022-3476
    E-ISSN: 1097-6833
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  • 4
    Language: English
    In: Neonatology, February 2015, Vol.107(2), pp.100-107
    Description: Background: The fetal-to-neonatal transition is a complex process that includes changes in cardiac and respiratory systems. Objective: The aim of this study is to review the different methods of cardiocirculatory monitoring during the immediate neonatal transition period. Methods: A systematic search of PubMed and Ovid Embase was performed using the following terms: infant, newborn, newborn infant, neonate, neonates, heart, cardiac, blood pressure, haemodynamic, hemodynamics, blood circulation, circulation, echocardiography, ultrasonography, sonography, electrocardiography, ECG, oximetry, pulse, pulse oximetry, monitoring, measurement, acclimatization, adaptation, transition, after birth and delivery room. Additional articles were identified by manual search of cited references. Only human studies describing cardiocirculatory monitoring during the first 15 min after birth were included. Results: Thirteen studies were identified that described heart rate (HR). Additional five studies were identified that measured blood pressure. Four studies performed functional echocardiography during neonatal transition; two in addition to blood pressure monitoring and three in addition to HR monitoring. Conclusion: Routine HR monitoring using electrocardiography or pulse oximetry is used to evaluate adequate hemodynamic transition, and reference ranges have been established. Measuring blood pressure noninvasively though noncontinuously might be of some value in future, considering that the normative data have been established recently. Echocardiographic monitoring during the immediate transition period will improve the knowledge about cardiac function changes, but introduction in clinical routine remains questionable. © 2014 S. Karger AG, Basel
    Subject(s): Review ; Neonate ; Transition ; Heart ; Circulation ; Heart Rate ; Blood Pressure ; Cardiac Function ; Medicine
    ISSN: 1661-7800
    E-ISSN: 1661-7819
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  • 5
    In: Frontiers in Pediatrics, 2017, Vol.5
    Description: Background Current European Guideline for resuscitation recommends a centrally positioned umbilical venous catheter as the best option for administering necessary drugs. Especially in preterm infants, a frequently used alternative is the peripheral venous catheter. Methods Two randomized controlled studies were conducted at the Division of Neonatology, Medical University of Graz. During neonatal resuscitation, a standardized protocol was filled out by an uninvolved observer including time points after birth of all attempts of venous puncture, time point of successful venous puncture, and total number of needed attempts. Arterial oxygen saturation (SpO 2 ) and heart rate (HR) were measured using pulse oximetry at the right hand/wrist. In each neonate, either NIRO 200NX (Hamamatsu, Japan) or INVOS 5100C (Covidien-Medtronic, USA) were used to measure cerebral tissue oxygenation index (cTOI) and cerebral regional oxygen saturation (crSO 2 ), respectively. SpO 2 , HR, and cTOI/crSO 2 during and 1 min before and after successful venous punctures were analyzed. Results 70 protocols were reviewed. Data of 61 preterm neonates were analyzed. Mean gestational age was 31.5 ± 2.2 weeks, and the mean birth weight was 1,527 ± 541 g. In median, it needed one attempt [interquartile range (IQR) 1–2] to establish a peripheral venous catheter. In median, intravenous (IV) catheterization was successfully established 5 (IQR 4–9) min after birth. SpO 2 and cTOI/crSO 2 rose significantly following the percentiles during the first 10 min after the birth. HR did not change significantly. Conclusion Peripheral IV catheterization during postnatal stabilization of preterm infants is feasible and successful in most of the cases at first attempt.
    Subject(s): Pediatrics ; Preterm Neonates ; Intravenous Access ; Postnatal Stabilization ; Arterial Oxygen Saturation ; Cerebral Oxygenation
    E-ISSN: 2296-2360
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  • 6
    Language: English
    In: Neonatology, 2017, Vol.111(1), pp.55-60
    Description: Substantial haemodynamic changes occur during the first minutes after birth. Currently, only heart rate (HR) and arterial oxygen saturation are routinely used to monitor haemodynamic transition after birth. The aim of the present study was to continuously assess haemodynamic changes during transition in term infants for the first time by using electrical velocimetry (EV), a new method of non-invasive cardiac output monitoring (NICOM), based on impedance cardiography technology. In this prospective observational study, term neonates delivered by elective caesarean section underwent NICOM measurements within the first 15 min after birth. The beat-to-beat measurement over a 10-second period was used to calculate cardiac output (CO) for each minute after birth. The data of CO were only accepted when the signal quality index (SQI) remained 〉80% during the measurement period of 10 s. 100 term neonates underwent 1,500 NICOM measurements. 1,143 (76.2%) measurements were excluded because of a SQI 〈80%. HR and CO showed a trend to increase within the first minutes, and decreased significantly from minute 3 (HR) and 4 (CO), until minute 12 and 10, respectively. Stroke volume remained stable during the observation period. The present study was the first using EV for NICOM during the transition period in a larger cohort of newborn infants. Results of NICOM were similar to available echocardiography data. The possibility of NICOM offers continuous CO measurement. The present study supports the idea that CO is closely related to HR in newborn infants.
    Subject(s): Cardiography, Impedance -- Methods ; Heart Rate -- Physiology ; Monitoring, Physiologic -- Instrumentation ; Stroke Volume -- Physiology
    ISSN: 1661-7800
    E-ISSN: 1661-7819
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  • 7
    In: Frontiers in Pediatrics, 2018, Vol.6
    Description: Background: Recently, we demonstrated that in healthy newborn infants cerebral blood volume (CBV) was decreasing continuously after birth. We hypothesized that this was due to the increase in oxygen delivery to the brain during neonatal transition. Thus delayed cerebral oxygen delivery in infants in need for respiratory support (RS) during postnatal stabilization might influence changes in CBV. Objective: Aim of the study was to evaluate transitional changes in CBV immediately after birth in term and preterm infants with and without need of RS. Methods: We performed a post-hoc analysis of data collected as primary and secondary outcome parameters in prospective observational studies and randomized controlled trials at the Medical University of Graz (Austria). NIRS measurements by using “NIRO 200-NX” (Hamamatsu, Japan) were carried out over the first 15 min after birth in term and preterm infants delivered by cesarean section with and without requirement for RS. Results: In 204 neonates, we observed a significant decrease in CBV within the first 15 min after birth ( p 〈 0.001) with a trend toward smaller ΔCBV in neonates receiving RS ( p = 0.097) compared to neonates without RS. Differences of ΔCBV between groups reached statistically significance ( p 〈 0.05) at minutes 2, 6, and 7, and showed a trend ( p 〈 0.1) at minutes 3, 4, and 5. After adjusting for gestational age, these differences became smaller and failed to reach significance. Conclusions: We observed a significant decrease of CBV in term and preterm infants with and without RS. Interestingly, ΔCBV was smaller in the first 7 min in neonates with RS reaching statistically significance ( p 〈 0.05) at minutes 2, 6, and 7. This study cannot differentiate, whether RS itself or the condition leading to requirement for RS is responsible for the observed CBV behavior.
    Subject(s): Pediatrics ; Cerebral Blood Volume ; Near-Infrared Spectroscopy (Nirs) ; Neonatal Transition ; Ventilation Induced Brain Injury ; Preterm Infants ; Ventilation
    E-ISSN: 2296-2360
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  • 8
    Language: English
    In: Neonatology, November 2015, Vol.108(4), pp.253-258
    Description: Background: Near-infrared spectroscopy (NIRS) enables non-invasive measurements of changes in the concentration of oxygenated (ΔHbO2) and reduced (ΔHbR) haemoglobin. Changes in total haemoglobin (ΔHbT = ΔHbO2 + ΔHbR) provide information on changes in cerebral blood volume (CBV). Objective: The aim was to evaluate the behaviour of CBV during immediate postnatal transition in term infants. Design: This observational study was conducted at the Medical University of Graz. NIRS measurements were carried out in term infants without need for respiratory support by using ‘NIRO 200-NX' (Hamamatsu) over the first 15 min after birth. Results: 109 infants with a mean gestational age of 38 + 6 weeks (±7 days) and birth weight of 3,242 g (±481) were included. Related to a reference value at minute 15, a significant decrease of HbT was observed for each minute within the study period. The mean (±SD) decrease of HbT of 17 (±40) µmol/l from minutes 2 to 15 represents a decrease of CBV of 1.0 ml/100 g brain (±2.2). Conclusions: In healthy newborns, CBV decreased over the whole study period. This likely reflects a physiological process. The impact and clinical relevance of different CBV behaviour during immediate transition needs to be investigated in further studies.
    Subject(s): Original Paper ; Cerebral Blood Volume ; Cerebral Tissue Oxygenation ; Neonatal Transition ; Near-Infrared Spectroscopy ; Medicine
    ISSN: 1661-7800
    E-ISSN: 1661-7819
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  • 9
    Language: English
    In: Neonatology, 2017, Vol.112(2), pp.97-102
    Description: Measurement of mean arterial blood pressure (MABP) is feasible during neonatal transition. The objective of this study was to investigate a potential influence of MABP on the cerebral regional oxygen saturation (crSO2) in preterm and term infants during the immediate neonatal transition. Preterm and term infants were included in this observational study. The crSO2 was measured by near-infrared spectroscopy with the INVOS 5100C (Somanetics Corp., Troy, MI, USA) during the immediate neonatal transition (15 min after birth). The near-infrared spectroscopy sensor was applied to the left forehead. Furthermore, a pulse oximeter was applied to monitor arterial oxygen saturation (SpO2) and heart rate (HR). Fifteen minutes after birth, blood pressure was measured noninvasively at the left upper arm. Cerebral fraction tissue oxygen extraction (cFTOE) was calculated from SpO2 and crSO2. To investigate a potential association between crSO2/cFTOE and MABP, we performed a correlation analysis. A total of 462 preterm and term infants (186/292) were included. Mean gestational age was 31.0 ± 3.5 weeks for preterm infants and 38.9 ± 0.8 weeks for full term infants. Mean birth weight was 1.591 ± 630 g in preterm infants and 3.331 ± 461 g in term infants. There was a significant negative correlation between MABP and cFTOE (ρ = -0.19, p = 0.03) in preterm infants but not in term infants (ρ = 0.05, p = 0.39). There was no significant correlation between MABP and crSO2 in either group. MABP has an impact on cerebral oxygenation in preterm infants. Therefore, blood pressure monitoring during the immediate neonatal transition might be relevant for improving cerebral oxygenation especially in preterm infants.
    Subject(s): Blood Pressure ; Cerebral Regional Oxygen Saturation ; Mean Arterial Blood Pressure ; Neonatal Transition ; Preterm Infants ; Term Neonates ; Arterial Pressure ; Cerebrovascular Circulation ; Oxygen Consumption ; Brain -- Blood Supply ; Oxygen -- Blood ; Premature Birth -- Physiopathology ; Upper Extremity -- Blood Supply
    ISSN: 1661-7800
    E-ISSN: 1661-7819
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  • 10
    Language: English
    In: Neonatology, November 2015, Vol.108(4), pp.283-286
    Description: Background: Non-invasive monitoring of the brain with near-infrared spectroscopy (NIRS) during immediate transition after birth is of growing interest. Objective: The aim of this work was to define reference ranges and centile charts for a regional cerebral tissue oxygenation index (cTOI), measured with the NIRO 200NX (NIRO, Hamamatsu, Japan), and cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 min after birth in preterm and term neonates without any medical support. Methods: cTOI was measured with the NIRO 200NX during the first 15 min after delivery via Caesarean section in preterm and term infants. The NIRS-sensor was placed on the right forehead. Peripheral arterial oxygen saturation (SpO2) and heart rate were continuously measured by pulse oximetry. cFTOE was calculated out of cTOI and SpO2. Neonates with a requirement for any medical support were excluded. Results: A total of 230 neonates were enrolled, from which 90 had to be excluded. Therefore, 140 term neonates were included and data were used to define reference ranges and centile charts. The 50th centile (10th to 90th centiles) of cTOI was 56% (39-75) at 2 min, 66% (50-78) at 5 min, 75% (62-85) at 10 min and 73% (61-84) at 15 min after birth. The 50th centile of cFTOE was 0.24 (0.11-0.44) at 2 min, 0.20 (0.10-0.35) at 5 min, 0.21 (0.09-0.35) at 10 min and 0.24 (0.13-0.37) at 15 min after birth. Conclusion: The present observational study adds the reference ranges and centile charts of cTOI measured with the NIRO 200NX and cFTOE calculated out of cTOI and SpO2 in neonates during the immediate neonatal transition. Centiles for each instrument will be necessary for future clinical application, since the differences between cTOI and cerebral regional tissue oxygen saturation measured with INVOS 5100C change with increasing regional oxygenation.
    Subject(s): Short Communication ; Reference Range ; Neonates ; Cerebral Tissue Oxygen Saturation ; Neonatal Transition ; Medicine
    ISSN: 1661-7800
    E-ISSN: 1661-7819
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