@article{a75ba37e76de4268942024bcba143d2f,
title = "Early brain and abdominal oxygenation in extremely low birth weight infants",
abstract = "Background: Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined. Methods: A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables. Results: In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001). Conclusion: Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population. Impact: Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies.Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases.A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome.Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.",
author = "{for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network} and Chock, {Valerie Y.} and Emily Smith and Sylvia Tan and Ball, {M. Bethany} and Abhik Das and Hintz, {Susan R.} and Haresh Kirpalani and Bell, {Edward F.} and Chalak, {Lina F.} and Carlo, {Waldemar A.} and Cotten, {C. Michael} and Widness, {John A.} and Kennedy, {Kathleen A.} and Ohls, {Robin K.} and Seabrook, {Ruth B.} and Patel, {Ravi M.} and Laptook, {Abbot R.} and Toni Mancini and Sokol, {Gregory M.} and Walsh, {Michele C.} and Yoder, {Bradley A.} and Poindexter, {Brenda B.} and Sanjay Chawla and D{\textquoteright}Angio, {Carl T.} and Higgins, {Rosemary D.} and {Van Meurs}, {Krisa P.}",
note = "Funding Information: The National Institutes of Health, National Heart, Lung, and Blood Institute (R01HL12216701A1, U01 HL112776, U01 HL112748), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (U10 HD21373, UG1 HD21364, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880, UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284; UG1 HD87226, UG1 HD87229) and the National Center for Advancing Translational Sciences (NCATS) (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR105, UL1 TR442, UL1 TR454, UL1 TR1117) provided grant support for the Neonatal Research Network. Funding Information: This study was supported by loan of equipment from Medtronic (Minneapolis, MN). The authors have no additional conflicts of interest to disclose. Funding Information: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Heart, Lung, and Blood Institute (NHLBI), the National Center for Research Resources (NCRR), and the National Center for Advancing Translational Sciences (NCATS) provided grant support for the Neonatal Research Network{\textquoteright}s Transfusion of Preemies (TOP) trial through cooperative agreements. While NICHD and NHLBI staff had input into the trial design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. Data collected at participating sites of the NICHD Neonatal Research Network were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data included in this trial. On behalf of the NRN, RTI International had full access to all the data in the trial and take responsibility for the integrity of the data and accuracy of the data analysis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this trial. The investigators listed in Supplementary Table S3 , in addition to those listed as authors, participated in this trial. Funding Information: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Heart, Lung, and Blood Institute (NHLBI), the National Center for Research Resources (NCRR), and the National Center for Advancing Translational Sciences (NCATS) provided grant support for the Neonatal Research Network{\textquoteright}s Transfusion of Preemies (TOP) trial through cooperative agreements. While NICHD and NHLBI staff had input into the trial design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. Data collected at participating sites of the NICHD Neonatal Research Network were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data included in this trial. On behalf of the NRN, RTI International had full access to all the data in the trial and take responsibility for the integrity of the data and accuracy of the data analysis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this trial. The investigators listed in Supplementary Table , in addition to those listed as authors, participated in this trial. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.",
year = "2022",
month = oct,
doi = "10.1038/s41390-022-02082-z",
language = "English",
volume = "92",
pages = "1034--1041",
journal = "Pediatric Research",
issn = "0031-3998",
number = "4",
}