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      Metabolic brain measurements in the newborn: Advances in optical technologies

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          Abstract

          Neonatal monitoring in neonatal intensive care is pushing the technological boundaries of newborn brain monitoring in order to improve patient outcome. There is an urgent need of a cot side, real time monitoring for assessment of brain injury severity and neurodevelopmental outcome, in particular for term newborn infants with hypoxic‐ischemic brain injury. This topical review discusses why brain tissue metabolic monitoring is important in this group of infants and introduces the currently used neuromonitoring techniques for metabolic monitoring in the neonatal intensive care unit (NICU). New optical techniques that can monitor changes in brain metabolism together with brain hemodynamics at the cot side are presented. Early studies from these emerging technologies have demonstrated their potential to deliver continuous information regarding cerebral physiological changes in sick newborn infants in real time. The promises of these new tools as well as their potential limitations are discussed.

          Abstract

          A summary of the available metabolic neuromonitoring techniques is shown in the abstract diagram.

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          Use of tissue oxygenation index and fractional tissue oxygen extraction as non-invasive parameters for cerebral oxygenation. A validation study in piglets.

          S V Huffel, Michael P Casaer, Gunnar Naulaers … (2006)
          To evaluate the relation between cerebral tissue oxygenation index (TOI), measured with spatially resolved spectroscopy (SRS), and the different oxygenation parameters. To evaluate the relation between a new parameter named fractional tissue oxygen extraction (FTOE) and the cerebral fractional oxygen extraction (FOE). Six newborn piglets were measured at 33, 35, and 37 degrees C and in hypocapnia. Mean arterial blood pressure (MABP), haemoglobin (Hb), peripheral oxygen saturation (S(a)O(2)) and P(a)CO(2) were measured at each step. Cerebral blood flow (CBF) was measured by injection of coloured microspheres into the left atrium. Jugular bulb oxygen saturation (JVS), cerebral arterial and venous oxygen content (C(a)O(2) and C(v)O(2)) and FOE were calculated. TOI of the brain was calculated and FTOE was introduced as (S(a)O(2) - TOI)/S(a)O(2). The correlation was calculated with an ANCOVA test. There was a positive correlation (R = 0.4 and p = 0.011) between TOI and JVS. No correlation was found with CBF, MABP or Hb. There was a positive correlation between P(a)CO(2) and cerebral TOI (R = 0.24 and p = 0.03). FTOE correlated well with FOE (R = 0.4 and p = 0.016) and there was a negative correlation between FTOE and P(a)CO(2) (R = 0.24, p = 0.03). The measurement of TOI and FTOE by SRS correlated well with the cerebral venous saturation and FOE, respectively.
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            Hypoxic-ischemic encephalopathy in the term infant.

            Ali Fatemi, Mary Wilson, Michael V Johnston (2009)
            Hypoxia-ischemia in the perinatal period is an important cause of cerebral palsy and associated disabilities in children. There has been significant research progress in hypoxic-ischemic encephalopathy over the last 2 decades, and many new molecular mechanisms have been identified. Despite all these advances, therapeutic interventions are still limited. In this article the authors discuss several molecular pathways involved in hypoxia-ischemia, and potential therapeutic targets.
            Article 0 comments Cited 67 times – based on 0 reviews     Review now
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              Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review.

              Henriëtte E. van der Horst, Norman Lee, Bart Post … (2012)
              Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia in term neonates causes long-term neurologic sequelae or death. A reliable evidence-based prognosis is essential. The study goal was to investigate the prognostic value of currently used clinical tests in neonatal patients with perinatal asphyxia and HIE. Searches were made on MEDLINE, Embase, Central, and CINAHL for studies occurring between January 1980 and November 2011. Studies were included if they (1) evaluated outcome in term infants with perinatal asphyxia and HIE, (2) evaluated prognostic tests, and (3) reported outcome at a minimal follow-up age of 18 months. Study selection, assessment of methodologic quality, and data extraction were performed by 3 independent reviewers. Pooled sensitivities and specificities of investigated tests were calculated when possible. Of the 259 relevant studies, 29 were included describing 13 prognostic tests conducted 1631 times in 1306 term neonates. A considerable heterogeneity was noted in test performance, cut-off values, and outcome measures. The most promising tests were amplitude-integrated electroencephalography (sensitivity 0.93, [95% confidence interval 0.78-0.98]; specificity 0.90 [0.60-0.98]), EEG (sensitivity 0.92 [0.66-0.99]; specificity 0.83 [0.64-0.93]), and visual evoked potentials (sensitivity 0.90 [0.74-0.97]; specificity 0.92 [0.68-0.98]). In imaging, diffusion weighted MRI performed best on specificity (0.89 [0.62-0.98]) and T1/T2-weighted MRI performed best on sensitivity (0.98 [0.80-1.00]). Magnetic resonance spectroscopy demonstrated a sensitivity of 0.75 (0.26-0.96) with poor specificity (0.58 [0.23-0.87]). This evidence suggests an important role for amplitude-integrated electroencephalography, EEG, visual evoked potentials, and diffusion weighted and conventional MRI. Given the heterogeneity in the tests' performance and outcomes studied, well-designed large prospective studies are needed.
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                Author and article information

                Contributors
                Ilias Tachtsidis:
                ORCID: https://orcid.org/0000-0002-8125-0313
                i.tachtsidis@ucl.ac.uk
                Journal
                Journal ID (nlm-ta): Physiol Rep
                Journal ID (iso-abbrev): Physiol Rep
                Journal ID (doi): 10.1002/(ISSN)2051-817X
                Journal ID (publisher-id): PHY2
                Journal ID (hwp): physreports
                Title: Physiological Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2051-817X
                Publication date (Electronic): 05 September 2020
                Publication date Collection: September 2020
                Volume: 8
                Issue: 17 ( doiID: 10.1002/phy2.v8.17 )
                Electronic Location Identifier: e14548
                Affiliations
                [ 1 ] Medical Physics and Biomedical Engineering University College London London UK
                [ 2 ] Neonatology, EGA Institute for Women's Health University College London London UK
                Author notes
                [*] [* ] Correspondence

                Ilias Tachtsidis, University College London, Gower Street, London WC1E 6BT, UK.

                Email: i.tachtsidis@ 123456ucl.ac.uk

                Author information
                https://orcid.org/0000-0002-8125-0313
                Article
                Publisher ID: PHY214548
                DOI: 10.14814/phy2.14548
                PMC ID: 7507543
                PubMed ID: 32889790
                SO-VID: e0ec564e-2104-4c81-944f-87328399a879
                Copyright © © 2020 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 April 2020
                Date revision received : 27 July 2020
                Date accepted : 28 July 2020
                Page count
                Figures: 7, Tables: 2, Pages: 12, Words: 16440
                Categories
                Subject: Review
                Subject: Reviews
                Custom metadata
                source-schema-version-number 2.0
                cover-date September 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.1 mode:remove_FC converted:22.09.2020

                Keywords: biomarkers,cerebral metabolism,intensive care medicine,near‐infrared spectroscopy,neonatal medicine,optical monitoring
                Data availability:
                Keywords: biomarkers, cerebral metabolism, intensive care medicine, near‐infrared spectroscopy, neonatal medicine, optical monitoring

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