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Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life

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Abstract

Haemodynamic assessment during the transitional period in preterm infants is challenging. We aimed to describe the relationships between cerebral regional tissue oxygen saturation (CrSO2), perfusion index (PI), echocardiographic, and clinical parameters in extremely preterm infants in their first 72 h of life. Twenty newborns born at < 28 weeks of gestation were continuously monitored with CrSO2 and preductal PI. Cardiac output was measured at H6, H24, H48, and H72. The median gestational age and birth weight were 25.0 weeks (24–26) and 750 g (655–920), respectively. CrSO2 and preductal PI had r values < 0.35 with blood gases, lactates, haemoglobin, and mean blood pressure. Cardiac output significantly increased over the 72 h of the study period. Fifteen patients had at least one episode of low left and/or right ventricular output (RVO), during which there was a strong correlation between CrSO2 and superior vena cava (SVC) flow (at H6 (r = 0.74) and H24 (r = 0.86)) and between PI and RVO (at H6 (r = 0.68) and H24 (r = 0.92)). Five patients had low SVC flow (≤ 40 mL/kg/min) at H6, during which PI was strongly correlated with RVO (r = 0.98).

Conclusion: CrSO2 and preductal PI are strongly correlated with cardiac output during low cardiac output states.

What is Known:

• Perfusion index and near-infrared spectroscopy are non-invasive tools to evaluate haemodynamics in preterm infants.

• Pre- and postductal perfusion indexes strongly correlate with left ventricular output in term infants, and near-infrared spectroscopy has been validated to assess cerebral oxygenation in term and preterm infants.

What is New:

• Cerebral regional tissue oxygen saturation and preductal perfusion index were strongly correlated with cardiac output during low cardiac output states.

• The strength of the correlation between cerebral regional tissue oxygen saturation, preductal perfusion index, and cardiac output varied in the first 72 h of life, reflecting the complexity of the transitional physiology.

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Abbreviations

CrSO2 :

Cerebral regional tissue oxygen saturation

Hb:

Haemoglobin concentration in the blood

LVO:

Left ventricular output

MBP:

Mean blood pressure

NIRS:

Near-infrared spectroscopy

PaCO2 :

Partial arterial carbon dioxide

PDA:

Patent ductus arteriosus

PI:

Perfusion index

RVO:

Right ventricular output

SaO2 :

Arterial oxygen saturation

SVC:

Superior vena cava

TnECHO:

Targeted neonatal echocardiography

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Acknowledgements

The authors would like to acknowledge funding from the Natural Sciences and Engineering Research Council of Canada (NSERC) grant RGPIN-2015-04672 and the Fonds de Recherche du Québec–Santé (FRQS) grant 32600 [MD].

Funding

This study was supported by the Mallinckrodt Research Fund and partly supported by the Seventh European Framework Program (FP7-HEALTH-2010-4.2-1, grant agreement 260777, HIP Project).

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Author notes

  1. Mathieu Dehaes and Anie Lapointe contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, 3175 chemin de la Côte Sainte-Catherine, Montréal, Qc, H3T 1C5, Canada

    Marie Janaillac, Keith J. Barrington & Anie Lapointe

  2. Institute of Biomedical Engineering, University of Montreal, Montreal, Canada

    Thierry P. Beausoleil

  3. Research Centre, CHU Sainte-Justine, University of Montreal, Montreal, Canada

    Thierry P. Beausoleil & Mathieu Dehaes

  4. Department of Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Canada

    Marie-Josée Raboisson

  5. Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland

    Oliver Karam

  6. Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Canada

    Mathieu Dehaes

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  1. Marie Janaillac
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Contributions

MJ participated in the study conception and design, collected and interpreted data and wrote the first draft of the manuscript. TPB performed the statistical analysis. OK made substantial contribution to the study conception and design, to the data interpretation and revised the manuscript critically. MJR and KB provided serious critical intput during the study conception and critically reviewed the manuscript. MD supervised TPB during the statistical analysis, contributed significantly to the data interpretation, supervised the first draft of the manuscript and acted as the co-principal investigator for the study with AL. AL was the principal investigator, participed in the study conception, finalised data collection forms, supervised the data collection and the draft writing. All authors approved the final manuscript.

Corresponding author

Correspondence to Anie Lapointe.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethics board and scientific board committee of the Sainte-Justine University Health Center approved the study. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Janaillac, M., Beausoleil, T.P., Barrington, K.J. et al. Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life. Eur J Pediatr 177, 541–550 (2018). https://doi.org/10.1007/s00431-018-3096-z

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