Background Near-infrared spectroscopy (NIRS) enables non-invasive, continuous monitoring
of oxygenation and perfusion in different tissues. In several studies NIRS has been
described to have the potential to detect centralisation due to perfusion heterogeneity,
arterio-venous shunting and impaired autoregulation. Thus, peripheral muscle NIRS
measurement has the potential to provide information at early stages of inflammation also
due to infection, due to microvascular dysfunction, when other routine vital parameters
are still within normal ranges.
Objectives
Primary aim To assess, if pFTOE measured by five short NIRS (re-)applications within the
first 6 hours after birth differs in neonates with early onset infection and neonates
without infection.
Secondary aims To assess, if cerebral fractional tissue oxygen extraction (cFTOE) and
cFTOE/pFTOE measured by five short NIRS (re-)applications within the first 6 hours after
birth differs in neonates with early onset infection and neonates without infection. To
assess, if there is a difference in pFTOE, cFTOE and cFTOE/pFTOE between term and preterm
neonates.
Methods
Study population: Term and preterm neonates ≥30+0 weeks of gestation with respiratory
distress and risk factors for infection admitted to the neonatal intensive care unit
(NICU) on the first day after vaginal delivery or caesarean section on the first day
after birth will be eligible for this study. Inclusion criteria are signs of respiratory
distress at time-point of inclusion, age <6h and decision to conduct full life support.
There will be four groups consisted with term(1) and preterm(2) neonates with early onset
infection and term(3) and preterm(4) neonates without.
Procedure: Patients and maternal medical history, routinely sampled laboratory results
and blood culture will be documented in each neonate.
Measurement: The NIRS-measurement will take place once within 6 hours after birth. For
NIRS measurements the NIRO 200NX will be used and the NIRS sensors will be applied by
hand on the right forearm (pTOI) and on the left forehead (cTOI) until stable signals are
obtained for approximately 30 seconds, respectively. Then the sensors will be removed for
10sec rest period. After that the sensors will be reapplied in approximately the same
positions. This procedure will be repeated five times.
Level of originality As many term and preterm neonates are admitted to the NICU after
birth due to respiratory distress, there is growing interest in methods enabling to
recognize subtle early signs like micro-vascular dysfunction due to infection. In the
present study the investigators want to evaluate in neonates with respiratory distress if
peripheral muscle and cerebral FTOE measured by short reapplications with NIRS in the
first hours after birth enables to recognize early microvascular dysfunction and
compromised oxygenation due to infections.