Preterm infants undergoing laparotomy for necrotizing enterocolitis or spontaneous intestinal perforation display evidence of impaired cerebrovascular autoregulation. (March 2018)

• Record Type: Journal Article
• Authors: Kuik, Sara J.; van der Laan, Michelle E.; Brouwer-Bergsma, Margot T.; Hulscher, Jan B.F.; Absalom, Anthony R.; Bos, Arend F.; Kooi, Elisabeth M.W.
• Is Part Of: Early human development. Volume 118(2018)
• Page Start: 25
• Page End: 31
• Publication Date: 2018-03
• Subjects: NEC necrotizing enterocolitis -- SIP spontaneous intestinal perforation -- CAR cerebrovascular autoregulation -- NIRS near-infrared spectroscopy -- RcSO2 regional cerebral oxygen saturation -- cFTOE cerebral fractional tissue oxygen extraction -- MABP mean arterial blood pressure -- BW birth weight -- PDA patent ductus arteriosus -- GA gestational age -- IQR inter quartile range -- GMH germinal matrix hemorrhage -- IVH intraventricular hemorrhage -- TPE transient periventricular echodensities -- PVL periventricular leukomalacia; Necrotizing enterocolitis -- Laparotomy -- Cerebrovascular autoregulation -- Near-infrared spectroscopy -- Preterm infants; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2018.01.019
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Background: Preterm infants requiring surgery are at risk of impaired neurocognitive development caused, possibly, by cerebral ischemia associated with impaired cerebrovascular autoregulation (CAR). We evaluated CAR before, during, and after laparotomy. Study design: This was a hypothesis generating prospective observational cohort study. Subjects: We included preterm infants requiring surgery for necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). Before, during, and after surgery we measured cerebral oxygen saturation using NIRS and calculated cerebral fractional tissue oxygen extraction (cFTOE). Outcome measures: Impaired CAR was defined if correlation coefficients (rho) between mean cFTOE and mean arterial blood pressure values were ≤−0.30 with P < .05. We used logistic regression analyses to determine factors associated with impaired CAR. Results: Nineteen infants with median (IQR) GA 27.6 weeks (26.6–31.0), birth weight 1090 g (924–1430), and postnatal age 9 days (7–12) were included. CAR was impaired more often during surgery than before (12 versus 3, P = .02) or after (12 versus 0, P < .01). A higher PCO2 level was associated with impaired CAR during surgery (OR 3.04, 95% CI, 1.11–8.12 for every 1 kPa increase). Conclusions: More than half of preterm infants with NEC or SIP displayed evidence of impaired CAR during laparotomy. Further research should focus on mechanisms contributing to impaired CAR in preterm infants during surgery. Highlights: Preterm infants who undergo major surgery are at a greater risk of impaired neurodevelopment than their peers. Impaired cerebrovascular autoregulation during surgery might account for brain damage. More than half of infants with NEC or SIP displayed evidence for impaired cerebrovascular autoregulation during laparotomy.