Cerebral oxygen saturation and extraction in neonates with prenatally diagnosed congenital heart disease during the first 72 hours of life.

Mebius, M.J. (Mirthe Johanna) (2013) Cerebral oxygen saturation and extraction in neonates with prenatally diagnosed congenital heart disease during the first 72 hours of life. thesis, Medicine.

Text MebiusMJ.pdf Restricted to Registered users only Download (1MB)

Abstract

Introduction: Neonates with congenital heart disease (CHD) are at risk of neurodevelopmental compromise. Increasing evidence suggests that brain damage in CHD, caused by hypoxic-ischemic events, occurs during early life or even before birth. Therefore, the aim of this study is to explore the course of the cerebral oxygen saturation and extraction in prenatally diagnosed neonates with duct dependent congenital heart disease during the first 72 hours of life. Furthermore, we will compare the course of the cerebral oxygen saturation and extraction of neonates with a duct dependent pulmonary circulation and neonates with a duct dependent systemic circulation. Materials and methods: Term neonates with duct dependent CHD, who received Prostaglandin E1, were selected from a database at the University Medical Center Groningen if cerebral oxygen saturation (rcSO2) was routinely measured by Near Infrared Spectroscopy. Subsequently, they were categorized into either CHD with a duct dependent pulmonary circulation, or CHD with a duct dependent systemic circulation. Median rcSO2, fractional tissue oxygen extraction (FTOE), and arterial oxygen saturation (SpO2) were calculated every five minutes during a one-hour period every six hours during the first 72 hours of life. In addition, we obtained clinical characteristics that could have an association with the rcSO¬2, FTOE, or SpO2 from medical records. Results: Twenty-nine neonates were included in this study (median gestational age 39+2/7 weeks (range: 36+4/7-41+6/7 weeks), median birth weight 3370 grams (range: 1960-4065 grams)). Median baseline rcSO2 was 58.5%, increased to 62.5% on the second day (p-value 0.04) and 60.5% on the third day (p-value 0.047 compared to baseline). FTOE remained stable during the first 72 hours of life at 35%. In neonates with a duct dependent pulmonary circulation (n = 20), rcSO¬2 tended to increase during the first 72 hours of life with median values ranging from 57.8% on the first day to 60.3% on the third day. FTOE remained stable. In neonates with a duct dependent systemic circulation (n = nine), both rcSO2 and FTOE remained stable during the first 72 hours of life. Significant differences in the course of the rc¬SO¬¬2 between both subgroups occurred on the first day (duct dependent pulmonary circulation 57.8%, vs. duct dependent systemic circulation 62.3%, p-value 0.03) and the second day (59.6% vs. 62.3%, p-value 0.048) Furthermore, rcSO2 tended to be higher in the group with a duct dependent systemic circulation on the third day (66.7% vs. 60.3%, p-value 0.09). Discussion: This study shows that despite immediate treatment, rcSO2 remained low (mean values < 60%) in neonates with duct dependent CHD during the first 72 hours of life. Furthermore, rcSO2 tended to be lower in neonates with a duct dependent pulmonary circulation compared to neonates with a duct dependent systemic circulation, while FTOE was similar in both subgroups. This suggests a more hypoxic hypoxia, caused by a low SpO2. Moreover, these neonates might also suffer from a decreased cerebral blood flow caused by an enhanced pulmonary blood flow due to treatment with Prostaglandin E1 (ductal steal).

Item Type:	Thesis (Thesis)
Supervisor name:	Bos, Prof. Dr. A.F. and Kooi, Dr. E.M.W.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/61

Actions (login required)

View Item