Veen, T. van der (Tsjitske) (2014) Wat is het effect van lichaamshouding op de cerebrale, renale en abdominale zuurstofextractie gemeten met Near-Infrared Spectroscopy in prematuur geboren kinderen? thesis, Medicine.
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Abstract
Introduction Necrotizing enterocolitis is a rare, but severe gastrointestinal disease in premature born children. Currently it is not possible to predict which premature children eventually will develop NEC. Intestinal ischemia seems to play a role in the development of NEC. Near-infrared spectroscopy (NIRS) is a non-invasive and a relatively new method to measure tissue oxygen saturation, that can be used to get an impression of the perfusion of the underlying tissue. Since the body position can influence the tissue perfusion due to an effect of posture on perfusion, it is necessary to investigate the effect of position on the values obtained by NIRS monitoring before this technique can be used in the diagnostic process of NEC. Aim To analyse the effect of positional changes (prone, supine, left or right side) on the cerebral, renal, and abdominal oxygen saturation and extraction measured by NIRS in preterm infants with a gestational age (GA) ≤ 30 weeks in their first weeks after birth. Methods As part of a larger, observational prospective cohort study, preterm infants with a GA ≤30 weeks, or with a birth weight ≤ 1000 grams, or with a GA ≤ 32 weeks and a birth weight ≤1200 grams, who were admitted to the Neonatal Intensive Care of the University Medical Centre Groningen (UMCG) were included. After informed consent was obtained, NIRS monitoring was started within 72 hours after birth. For the purpose of this study, NIRS measurements performed at day 3, day 8, and day 22 were analyzed. Neonatal NIRS-somasensors were placed on the left front parietal side to measure the cerebral tissue oxygen saturation (rcSO2), on the left posterior flank between T10 and L2 to measure renal tissue oxygen saturation (rrSO2), and below the umbilicus on the central abdomen to measure abdominal tissue oxygen saturation (raSO2). FTOE (fractional tissue oxygen extraction) values were calculated for each position separately using the equation: FTOE = (SpO2) – rSO2) / SpO2. Results Thirty seven patients were included, with a median gestational age of 28.1 weeks and a range from 25.0 to 30.7 weeks and with a median birth weight of 1025 grams with a range from 580 to 1580 grams. On day 3, rrSO2 was significantly lower when measured in the left side versus supine position(p=0.013) and the left side versus prone position(p=0.016). There were no significant differences between the percentage successfully measurements in the four various position. No significant differences were found between various positions at day 8 and day 22 after birth. Conclusion RrSO2 values obtained in the left side position, were significantly lower compared to rrSO2 values obtained in the prone and supine position. This might be due to gravitational effects or methodical influences when the infant lies on the NIRS sensor. Further studies are needed with a larger patient population to confirm these results.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kooi, Dr. E.M.W. and Schat, T. E. MSc. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/582 |
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