Pediatric research
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Impaired cerebral autoregulation (CA) is common and is associated with brain damage in sick neonates. Frequency analysis using spontaneous changes in arterial blood pressure (ABP) and cerebral near-infrared spectroscopy (NIRS) has been used to measure CA in several clinical studies. Coherence of the NIRS and ABP signals (i.e. correlation in the frequency domain) detects impairment of CA, whereas gain (i.e. magnitude of ABP variability passing from systemic to cerebral circulation) estimates the degree of this impairment. ⋯ As expected, however, gain was significantly associated with CA capacity in measurements with significant coherence (r = -0.55, n = 15, p = 0.03). In conclusion, our data validate frequency analysis for estimation of CA in clinical research. Low precision, however, hampers its clinical application.
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Randomized Controlled Trial
Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass.
Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpulsatile flow on brain protection. Regional cerebral oxygen saturation (rSO2) and cerebrovascular pulsatility index (PI) were measured by NIRS and TCD, respectively, in 111 pediatric patients undergoing bypass for CHD repair randomized to pulsatile (n = 77) or nonpulsatile (n = 34) perfusion. ⋯ Patients undergoing pulsatile perfusion had numerically lower decreases in PI from baseline for the majority of time points compared with the nonpulsatile group, with significant ∼30% lower decreases between 5 and 40 min after crossclamp. Pulsatile flow has advantages over nonpulsatile flow as measured by NIRS and TCD, especially at advanced time points, which may improve postoperative neurodevelopmental outcomes.
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Sustained lung inflations (SIs) immediately after birth might decrease the need for subsequent mechanical ventilation in preterm infants. However, effects of SIs on oxygenation and hemodynamics are undetermined. Our aim was to study immediate effects of SIs on heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation in preterm infants supported with SIs after birth for lung recruitment. ⋯ During the last SIs, there was a rapid increase in the infants' heart rate and an increase in cerebral tissue oxygen saturation. Arterial saturation increased with slight delay. In conclusion, effective last sustained inflations increase heart rate and cerebral tissue oxygen saturation to be followed by an increase in arterial saturation.