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Am J Perinatol 2024; 41(04): 429-438
DOI: 10.1055/s-0041-1740513
Original Article

Role of Near-Infrared Spectroscopy in Monitoring the Clinical Course of Asphyxiated Neonates Treated with Hypothermia

Marwa Mohamed Farag 
1   Pediatric Department, Alexandria University Hospital, Alexandria, Egypt
,
Ahmed Abd El-Halim Abd El-Raziq Khedr
1   Pediatric Department, Alexandria University Hospital, Alexandria, Egypt
,
MennattAllah Hassan Attia 
2   Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
,
Hesham Abd EL-Rahim Ghazal
1   Pediatric Department, Alexandria University Hospital, Alexandria, Egypt
› Author Affiliations Funding None.
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Abstract

Objective Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course.

Study Design Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups.

Results Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up.

Conclusion NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not.

Key Points

  • Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI.

  • Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan.

  • Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia.

Keywords

hypoxic-ischemia - therapeutic hypothermia - clinical seizures - near-infrared spectroscopy - cRSO2 - FTOE

Note

Place of work: El-Shatbi Hospital, Pediatric Building, Faculty of Medicine, Sotir street, El Shatbi Medical Campus, Alexandria University, Alexandria Governorate, Egypt.


Ethical Approval

The study protocol has been approved by the Research Ethics Committee of Alexandria Faculty of Medicine: approval no. 0106082 in 8–19–2019 (date of approval). IRB no. is 00012098 and FWA no. is 00018699. Written informed consent was obtained from parents or authorized legal representatives of all newborns who participated in the study for publication of anonymous patients' data.


Supplementary Material



Publication History

Received: 01 June 2021

Accepted: 01 November 2021

Article published online:
29 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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