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|Title:||Early cerebral oxygen extraction and the risk of death or sonographic brain injury in very preterm infants|
|Citation:||Journal of Pediatrics, 2014; 164(3):475-480.e1|
|Kiran Kumar Balegar, Michael J. Stark, Nancy Briggs, and Chad C. Andersen|
|Abstract:||OBJECTIVE: To evaluate the relationship between cerebral fractional tissue oxygen extraction (cFTOE), a measure of oxygen delivery-consumption equilibrium, and the risk of early poor outcome in very preterm infants. STUDY DESIGN: Cerebral blood flow, tissue oxygenation index (by near-infrared spectroscopy), and arterial oxygen content were measured, and cerebral oxygen delivery, consumption, and cFTOE were calculated at 3 intervals in the first 72 hours of life in infants ≤ 30 weeks gestational age (GA). A receiver operating characteristic curve was derived with an a priori defined dichotomized outcome of good or poor, defined as death or sonographic brain injury (grade ≥ II intraventricular hemorrhage) by day 7. RESULTS: Seventy-one infants were enrolled, with a mean (SD) GA of 27 (2) weeks. cFTOE demonstrated better discrimination for the study outcome at <24 hours of age than at 48 or 72 hours of age (P = .01). The area under the curve for cFTOE at the initial measurement was no different from that for GA alone (0.87; 95% CI, 0.77-0.95 vs 0.81; 95% CI, 0.69-0.92), but the combined measure of cFTOE and GA had better discrimination (0.96; 95% CI, 0.91-1.0) than either cFTOE (P = .03) or GA (P = .016) alone. A cFTOE of 0.4 had a sensitivity of 82% and specificity of 75% for risk of early poor outcome. CONCLUSION: Elevated cFTOE values are associated with increased risk of early poor outcome in very preterm infants. Its predictive value is further improved with the addition of GA.|
|Keywords:||Carotid Artery, Internal; Humans; Cerebral Hemorrhage; Infant, Premature, Diseases; Oxygen; Spectroscopy, Near-Infrared; Echocardiography; Ultrasonography, Doppler, Pulsed; Oximetry; Respiration, Artificial; Logistic Models; Sensitivity and Specificity; ROC Curve; Gestational Age; Cerebrovascular Circulation; Regional Blood Flow; Infant, Newborn; Infant, Premature|
|Rights:||Copyright © 2014 Mosby Inc. All rights reserved.|
|Appears in Collections:||Obstetrics and Gynaecology publications|
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