Simultaneous measurement of cerebral hemoglobin oxygen saturation and blood volume in asphyxiated neonates by near-infrared time-resolved spectroscopy
Simultaneous measurement of cerebral hemoglobin oxygen saturation and blood volume in asphyxiated neonates by near-infrared time-resolved spectroscopy
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DOI：
10.1016/j.braindev.2015.04.002
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发表时间：
2015-11-01
影响因子：
1.7
通讯作者：
Kusaka, Takashi
中科院分区：
文献类型：
--
作者：
Nakamura, Shinji;Koyano, Kosuke;Kusaka, Takashi
背景：缺氧缺血性脑病（HIE）即使采用低温治疗（HT），通常也会导致不良的临床结局。出生后早期脑血氧和血流动力学的变化可能是脑损伤和HT疗效的关键决定因素。目的：我们通过近红外时间分辨光谱（TRS）测量HT治疗和非HT治疗的新生儿HIE患者的脑血红蛋白氧饱和度（ScO 2）和脑血容量（CBV），以评估这些参数对临床结局的影响。方法：我们回顾性比较了11例HIE新生儿的ScO 2、CBV和临床结局：5例接受HT治疗（HT治疗;从分娩后约6 h开始，33.5 ℃ +/- 0.5 ℃持续72 h），6例未接受HT治疗（未接受HT治疗）。于生后6、24、48和72 h用TRS测定CBV和ScO 2。出生后1-2周进行磁共振成像（MRI），以评估脑injure.Results：五个新生儿有不良后果（HT治疗3，非HT治疗2）。其中，1例在出生后3天内死亡，4例有异常MRI结果，包括基底节、白色物质和/或丘脑病变。其他6例新生儿的MRI结果正常（结局良好）。在出生后6小时，CBV是显着较高的新生儿与不利的结果相比，那些有利的结果。在出生后24小时，ScO 2显着较高的新生儿有不良后果。结论：新生儿出生后早期CBV和ScO 2升高对HIE预后有不良预测作用。因此，在出生后24小时测量CBV和ScO 2的组合可以更准确地预测神经学结局。控制出生后CBV和ScO 2是有效治疗HIE的关键。(C)2015日本儿童神经病学学会。Elsevier B. V.出版，保留所有权利。
Background: Hypoxic-ischemic encephalopathy (HIE) usually results in a poor clinical outcome even when treated with hypothermic therapy (HT). Early postnatal changes in cerebral blood oxygenation and hemodynamics may be critical determinants of brain injury and the efficacy of HT.Objectives: We measured cerebral hemoglobin oxygen saturation (ScO2) and cerebral blood volume (CBV) by near-infrared time-resolved spectroscopy (TRS) in HT-treated and non-HT-treated neonatal HIE patients to assess the influence of these parameters on clinical outcome.Methods: We retrospectively compared ScO2, CBV, and clinical outcomes of 11 neonates with HIE: 5 were treated by HT (HT-treated; 33.5 degrees C +/- 0.5 degrees C for 72 h starting approximately 6 h after delivery) and 6 were not (non-HT-treated). Both CBV and ScO2 were measured by TRS at 6, 24, 48, and 72 h after birth. Magnetic resonance imaging (MRI) was performed 1-2 weeks after birth to assess brain injury.Results: Five neonates had adverse outcomes (3 HT-treated, 2 non-HT-treated). Of these, 1 died within 3 days of birth and 4 had abnormal MRI findings, including basal ganglia, white matter, and/or thalamic lesions. The other 6 neonates had normal MRI findings (favorable outcome). At 6 h after birth, CBV was significantly higher in neonates with adverse outcomes compared with those with a favorable outcome. At 24 h after birth, ScO2 was significantly higher in neonates with adverse outcomes. Furthermore, we found that combined CBV at 24 h after birth plus ScO2 had the best predictive ability for neurological outcome: sensitivity, specificity, positive predictive value, and negative predictive value were all 100%.Conclusion: Early postnatal CBV and ScO2 elevations were predictive of a poor outcome in HIE. Therefore, measuring combined CBV plus ScO2 at 24 h after birth can allow more precise prediction of neurological outcome. Control of postnatal CBV and ScO2 is critical for effective HIE treatment. (C) 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.