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Clinical use of cerebral oximetry in extremely preterm infants is feasible.
MedLine Citation:
PMID:  23340184     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
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
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Danish medical journal     Volume:  60     ISSN:  2245-1919     ISO Abbreviation:  Dan Med J     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101576205     Medline TA:  Dan Med J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  A4533     Citation Subset:  IM    
Affiliation:
Neonatalklinikken, Afsnit 5021, Rigshospitalet, 2100 Copenhagen, Denmark. simonhyttelsrensen@me.com.
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