Cerebral tissue oxygenation index, cardiac output and superior vena cava flow in infants with birth weight less than 1250 grams in the first 48 hours of life

BackgroundNear-infrared spectroscopy is a non-invasive method of assessing cerebral oxygenation. Functional echocardiography is increasingly used by neonatologists in the assessment of cardiovascular function.AimsTo correlate cerebral tissue oxygenation index (cTOI) and cardiac output in infants less than 1250 g at 6, 12, 24 and 48 hours of age.Study designA prospective observational study.SubjectsNewborns with birth weight < 1250 g.Outcome measuresSerial assessments of superior vena cava (SVC) flow, right and left ventricular outputs, ductus arteriosus and cTOI were performed at 6, 12, 24 and 48 hours of age. Clinical parameters, including mean blood pressure, mean airway pressure, blood gas parameters and oxygen saturations were recorded.Results22 neonates were enrolled following parental consent. The mean birth weight was 851 g (SD ± 201), mean gestational age was 25.9 weeks (SD ± 1.7). Mean SVC flow at 6 hours of age was 56.8 ml/kg/min and increased to 68.6 ml/kg/min at 48 hours of age. 9 infants (41%) had at least one measurement of low SVC flow (< 41 ml/kg/min) in the first 48 hours. Mean cTOI was 65.2% at 6 hours of age, 63.9% at 12 hours of age, 68.8% at 24 hours of age and 67.2% at 48 hours of age. Cerebral fractional tissue oxygen extraction values were highest at 12 hours (0.31 ± 0.09). There was no correlation between SVC flow and cTOI values.ConclusionSVC flow, left and right ventricular output increased during first 48 hours of life. cTOI decreased at 12 hours of age with a concomitant increase in fractionated oxygen extraction. These changes reflect transitional changes in both cardiac and cerebral hemodynamics in extremely low gestational age newborns during the first 48 hours.