Effect van fototherapie op weefselsaturatie.

Knegt, J.M. (2013) Effect van fototherapie op weefselsaturatie. thesis, Medicine.

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Abstract

Background: Premature infants are vulnerable and often have numerous problems which require treatment. One of these problems is hyperbilirubinemia. The treatment for this is phototherapy. Phototherapy is considered safe, but there are documented effects on blood vessels, including a change in the blood flow to the intestines. Altered intestinal perfusion plays a role in another common problem in premature infants the incidence of necrotizing enterocolitis (NEC). Near infrared spectroscopy (NIRS), a non-invasive manner of a continuous measurement, has recently made it possible to carry out the oxygen saturation level of the underlying tissue. This makes it possible to study any effects of phototherapy on the intestinal oxygen saturation and fractional oxygen extraction. Aim: The aim of the study was to analyze whether phototherapy affects tissue saturation from cerebral, renal and abdominal . Method: In this study, preterm infants gestational age <32 weeks enrolled in the California study. The California study aims to identify non-invasive markers for necrotizing enterocolitis (NEC). The NIRS sensors were placed on head, left flank and belly for 2 hours on days 3,4 and 5. We also looked which premature had phototherapy and which are not. The FTOE (Fractional Tissue Oxygen Extraction) is calculated from the rSO2 and the SpO2 by formula. The FTOE shows the relationship between the oxygen (SpO2 = transcutaneously measured arterial oxygen saturation) and regional tissue saturation: the rSO2. To see if there is an effect of phototherapy on cerebral rSO2, renal rSO2 and abdominal rSO2 and corresponding FTOE intra individual values were compared (namely the values with and without phototherapy). The corresponding values were also compared between groups with and without children under phototherapy. Also, we went in multivariate or was getting NEC affected by phototherapy. For this, a logistic regression analysis was performed with phototherapy as variable and NEC as an outcome measure. Results: There were 28 premature infants included, 14 men and 14 women, with a gestational age ranging from 26 to 30+1 week. Of these there were 20 during the study that had one or more day’s phototherapy. Six premature infants eventually developed NEC. The cerebral rSO2 for premature infants with phototherapy (n10) is significantly lower (p=0,009) than for the same premature infants without phototherapy. There were significant difference in cerebral rSO2, renal rSO2 and abdominal rSO2 between groups who did (n=10) and did not(n=8) had phototherapy on days, 3, 4 and 5. There was no difference in the intestinal FTOE between preterm infants with and without NEC. The abdominal rSO2/cerebral rSO2 ratio was, on day 4 for premature infants with NEC higher. In our data it was found that phototherapy had no effect on the development of NEC. Conclusion: The cerebral rSO2 was lower as was a premature treated with phototherapy. However, between the groups who did and did not phototherapy we found no difference in cerebral rSO2, nor in renal rSO2 and abdominal rSO2. The intestinal oxygen extraction between preterm infants with and without NEC was also the same.

Item Type:	Thesis (Thesis)
Supervisor name:	Hulzebos, Dr. C.V.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:46
Last Modified:	25 Jun 2020 10:46
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/759

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