ASSESSING GUT OXYGENATION IN PREMATURE INFANTS USING NEAR INFRARED SPECTROMET

使用近红外光谱仪评估早产儿肠道氧合情况

• 批准号: 8166678
• 负责人: OLUYINKA OLUROTIMI OLUTOYE
• 金额: $ 0.81万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2010-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8166678
• 关键词: Acute Abdomen; Analgesics; Apnea; Birth; Blood; Bradycardia; Brain; Cerebrum; Characteristics; Child; Clinical; Comorbidity; Computer Retrieval of Information on Scientific Projects Database; Data; Development; Disease; Due Process; Etiology; Feeds; Funding; Future; Grant; Hemoglobin; Hypotension; Incidence; Infant; Institution; Intestinal Diseases; Intestines; Light; Measurement; Measures; Near-Infrared Spectroscopy; Necrotizing Enterocolitis; Newborn Infant; Normal Range; Oral; Oxygen; Oxyhemoglobin; Perfusion; Peripheral; Physiologic pulse; Population; Premature Infant; Process; Publishing; Research; Research Personnel; Resources; Risk; Side; Signal Transduction; Source; Time; Tissues; United States National Institutes of Health; Venous; absorption; adverse outcome; capillary bed; deoxyhemoglobin; falls; feeding; indexing; intraventricular hemorrhage; neonate; oxidation; patient population; respiratory; respiratory distress syndrome; sedative; standard of care

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Infants who have lower measures of gut oxygenation (compared to brain) are more likely to develop Necrotizing enterocolitis (NEC) or other intestinal disease and to have feeding intolerance. The primary objective of this project is to establish a baseline for normal values of NIRS measurements in premature infants and to establish what changes exist, if any with feeding. Because the incidence of NEC is around 5% in this patient population, we will be able to generate some pilot data on the usefulness of NIRS in predicting NEC. I. To obtain "normal" intestinal tissue oxidation index values (TOI) in newborns weighing 750 to 1500g. 2. To obtain a cerebro-splanchnic oxgenation ration (CSOR) for each child in order to compare values at separate time points (at 1,2,3, and 4 weeks after birth). 3. To correlate decreasing CSOR and TOI with the development of NEC or other intestinal disease, if it occurs. 4. To obtain "normal" values of increased intestinal TOI during feeding at 1,2,3, and 4 weeks after birth. 5. To correlate a blunted intestinal TOI increase with feeding with the onset of feeding intolerance, if it occurs. Premature infants are at risk for neurodevelopmental adverse outcomes from a number of causes, including hypotoxic-ischemic insults from the delivery process, respiratory distress syndrome, intraventricular hemorrhage, sedative and analgesic drugs, and apnea/bradycardia. In addition, premature infants frequently develop necrotizing enterocolitis (NEC), the etiology of which is still unclear, but may be related to decreased gut perfusion. Near-infrared spectroscopy (NIRS) measures cerebral and somatic oxygenation with two wavelengths of light to which oxy-and deoxyhemoglobin have distinct absorption characteristics. The oxyhemoglobin and total hemoglobin signals are measured, and a regional cerebral or intestinal oxyhemoglobin saturation ratio is calculated (tissue oxidation index, or TOI). Low intestinal TOI may help explain the high incidence of necrotizing enterocolitis in this population. Cerebral perfusion is autoregulated, therefore, a splanchnic: cerebral perfusion ratio should remain constant under normal conditions, but should be expected to fall during hypotension or sschemia. A recently published study showed a significant difference between the brain/gut ratio of TOI between neonates with NEC/acute abdomen and those without. However, there is no data to prove that a decreasing ration predicts these problems (i.e., is the decrease in gut perfusion as a result of the disease process, or is the disease process due to the decrease in gut perfusion?). As mentioned in our specific aims, obtaining normal values are critical for future studies. Without any data, it is difficult to speculate, but the ideal clinical situation would be to establish a "cut off" point. Put in different terms, what we hope we will find is a number that defines abnormal gut perfusion and predicts feeding intolerance. The numbers will be presented as real values, which the machine expresses as percentage StO2. This value represents the percentage of oxygenated hemoglobin divided by the total hemoglobin. As this value is measured on the venous side of the capillary bed, it reflects blood oxygenation status after tissue oxygen extraction. The StO2 (5) will be compared to SPO2 (%) of the peripheral pulse oximeter (arterial side of peripheral capillary bed), as well as any ABGs that have been drawn per standard of care (if any). These vlaues will be examined with respect to oral feeds, respiratory rate, and any oxygenation and perfusion co-morbidities.

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 肠道含氧量较低的婴儿(与大脑相比)更有可能发展为坏死性小肠结肠炎(NEC)或其他肠道疾病，并出现喂养不耐受。该项目的主要目标是建立早产儿近红外光谱测量正常值的基线，并确定在喂养过程中存在哪些变化。由于NEC在这一患者群体中的发病率约为5%，我们将能够产生一些关于NIRS在预测NEC方面的有用性的初步数据。 1.获得体重750-1500克新生儿的“正常”肠道组织氧化指数值(TOI)。 2.获取每个儿童的大脑-内脏氧合比(CSOR)，以便比较不同时间点(出生后1、2、3和4周)的值。 3.探讨CSOR和TOI降低与NEC或其他肠道疾病的发生发展的关系。 4.获得出生后1、2、3、4周喂养时肠道TOI升高的“正常”值。 5.研究进食时钝性肠道TOI增加与进食不耐受的发生之间的关系。 早产儿面临多种原因造成的神经发育不良后果，包括分娩过程中的低毒缺血性损伤、呼吸窘迫综合征、脑室出血、镇静和止痛药以及呼吸暂停/心动过缓。此外，早产儿经常发生坏死性小肠结肠炎(NEC)，其病因尚不清楚，但可能与肠道灌注量减少有关。 近红外光谱(NIRS)测量大脑和躯体的氧合作用具有两个波长的光，氧合和脱氧血红蛋白对这两个波长具有明显的吸收特性。测量氧合血红蛋白和总血红蛋白信号，并计算局部脑或肠道氧合血红蛋白饱和度比率(组织氧化指数，TOI)。低肠TOI可能有助于解释坏死性小肠结肠炎在该人群中的高发病率。脑血流灌注是自动调节的，因此，内脏：脑血流灌注率在正常情况下应保持恒定，但在低血压或缺血时应预期下降。最近发表的一项研究表明，患有NEC/急腹症的新生儿和没有患急腹症的新生儿的大脑/肠道TOI比率有显著差异。然而，没有数据证明降低的比例可以预测这些问题(即肠道灌注量的减少是疾病过程的结果，还是疾病过程的肠道灌注量减少所致？)。 正如我们在具体目标中提到的那样，获得正常值对于未来的研究至关重要。在没有任何数据的情况下，很难推测，但理想的临床情况将是建立一个“截止点”。换句话说，我们希望找到的是一个定义肠道灌注异常并预测喂养不耐受的数字。 这些数字将显示为实际值，机器将其表示为百分比StO2。该值表示含氧血红蛋白的百分比除以总血红蛋白。由于该值是在毛细血管床的静脉侧测量的，因此它反映了组织氧提取后的血液氧合状态。将血氧饱和度(5)与外周脉搏血氧饱和度(外周毛细血管床的动脉侧)的SpO2(%)以及根据护理标准(如果有)提取的任何ABG进行比较。检查这些指标包括：口腔喂养、呼吸频率以及任何氧合和灌注并发症。