Changes in Cerebral Oxygenation in Preterm Infants With Progressive Posthemorrhagic Ventricular Dilatation

Pediatr Neurol. 2017 Aug;73:57-63. doi: 10.1016/j.pediatrneurol.2017.05.012. Epub 2017 May 25.

Abstract

Background: Optimal timing of intervention in neonatal progressive posthemorrhagic hydrocephalus is often a difficult decision. Unchecked hydrocephalus can lead to irreversible brain injury through impaired perfusion, while placement of a shunt is not without long-term morbidity. The purpose of this study was to assess the use of near-infrared spectroscopy to measure changes in regional cerebral oxygen saturation as an indicator of cerebral perfusion in infants with progressive posthemorrhagic ventricular dilatation.

Methods: Near-infrared spectroscopy was used to measure regional cerebral oxygen saturation for more than a one-hour period in infants within 24 hours of cranial ultrasound. Simultaneous pulse oximetry was recorded and oxygen extraction was calculated. Ventricular size was measured by ultrasound using the frontal-occipital horn ratio and compared with average oxygen saturation and oxygen extraction. Statistical analysis was done using the Spearman rank test and analysis of variance.

Results: Ventricular measurements were made in 20 very low birth weight premature infants with periventricular-intraventricular hemorrhage and 12 infants with normal ultrasound scans. Ventricular dilatation was associated with lower cerebral oxygen saturation and higher oxygen extraction (P < 0.001). Progressive ventricular dilatation was inversely related to changes in cerebral oxygen saturation (P < 0.001).

Conclusions: Progressive posthemorrhagic ventricular dilatation is associated with a significant decrease in cerebral oxygenation and increase in oxygen extraction suggesting a decrease in cerebral perfusion. Near-infrared spectroscopy could potentially provide additional clinical information to assist in determining optimal timing of surgical intervention in preterm infants with progressive ventricular enlargement.

Keywords: cerebral oxygenation; near-infrared spectroscopy; periventricular-intraventricular hemorrhage; posthemorrhagic hydrocephalus; preterm neonate.

MeSH terms

  • Carbon Dioxide / analysis
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / etiology*
  • Cerebral Ventricles / pathology*
  • Cerebrovascular Circulation / physiology*
  • Dilatation, Pathologic
  • Disease Progression
  • Female
  • Gestational Age
  • Humans
  • Hydrocephalus / complications*
  • Hydrocephalus / diagnostic imaging
  • Infant
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / pathology
  • Infant, Premature, Diseases / physiopathology
  • Male
  • Oximetry
  • Oxygen / analysis*
  • Spectroscopy, Near-Infrared

Substances

  • Carbon Dioxide
  • Oxygen