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Correlation of Cerebral Near-Infrared Spectroscopy (cNIRS) and Neurological Markers in Critically Ill Children

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Abstract

Objective

To correlate regional brain saturations (RSO2) measured by cerebral Near-infrared spectroscopy (cNIRS) with serological markers indicative of neurological injury (neuron-specific enolase (NSE) and S100β).

Methods

Children with at least one organ failure who were undergoing cNIRS monitoring were eligible for enrollment, while children with hyperbilirubinemia and cyanotic heart disease were excluded. Children were further analyzed based on the presence of an acute neurological injury (defined as hypoxic/ischemic injury after cardiac arrest, status epilepticus, meningitis, encephalopathy) as well as survival. RSO2 was measured continuously (every 30 s) and averages were obtained at 6 h and 24 h epochs prior to serum collection (E6 and E24, respectively). Serum was collected for NSE and S100β, which were both determined by ELISA. Serum from children undergoing evaluation for fever in the Emergency department served as serological controls. Correlations were determined using the Pearson Product Moment Correlations.

Results

A total of 26 children underwent cNIRS monitoring for a total of 47 days. Overall NSE was greater in critically ill children compared to controls, as well as in all subsets of children analyzed (acute CNS injuries, no acute CNS injuries, survivors and non-survivors). S100β tended to be greater in critically ill children, but this did not reach statistical significance. Average RSO2 in E6 and E24 was 68.0% ± 1.5 and 68.6% ± 1.6, respectively, in a total of 131,036 measurements and E6 RSO2 was strongly, negatively correlated with S100β in children with acute neurological injuries.

Conclusions

This is the first study to correlate averaged RSO2 measured by cNIRS with neurological injury markers in critically ill children. We believe that this data can be used to establish thresholds for RSO2 that can be tested in future trials to determine if this technology is predictive of long-term neurological outcome.

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References

  1. Bone RC, Sprung CL, Sibbald WJ. Definitions for sepsis and organ failure. Crit Care Med. 1992;20:724–6.

    Article  CAS  PubMed  Google Scholar 

  2. Osterlundh G, Kjellmer I, Lannering B, et al. Neurochemical markers of brain damage in cerebrospinal fluid during induction treatment of acute lymphoblastic leukemia in children. Pediatr Blood Cancer. 2008;50:793–8.

    Article  PubMed  Google Scholar 

  3. Berger RP, Beers SR, Richichi R, et al. Serum biomarker concentrations and outcome after pediatric traumatic brain injury. J Neurotrauma. 2007;24:1793–801.

    Article  PubMed  Google Scholar 

  4. Nguyen DN, Spapen H, Su F, et al. Elevated serum levels of S-100beta protein and neuron-specific enolase are associated with brain injury in patients with severe sepsis and septic shock. Crit Care Med. 2006;34:1967–74.

    Article  CAS  PubMed  Google Scholar 

  5. Thorngren-Jerneck K, Alling C, Herbst A, et al. S100 protein in serum as a prognostic marker for cerebral injury in term newborn infants with hypoxic ischemic encephalopathy. Pediatr Res. 2004;55:406–12.

    Article  CAS  PubMed  Google Scholar 

  6. Tiainen M, Roine RO, Pettila V, Takkunen O. Serum neuron-specific enolase and S-100B protein in cardiac arrest patients treated with hypothermia. Stroke. 2003;34:2881–6.

    Article  CAS  PubMed  Google Scholar 

  7. Abdul-Khaliq H, Schubert S, Stoltenburg-Didinger G, et al. Release patterns of astrocytic and neuronal biochemical markers in serum during and after experimental settings of cardiac surgery. Restor Neurol Neurosci. 2003;21:141–50.

    CAS  PubMed  Google Scholar 

  8. Tanabe T, Suzuki S, Hara K, et al. Cerebrospinal fluid and serum neuron-specific enolase levels after febrile seizures. Epilepsia. 2001;42:504–7.

    Article  CAS  PubMed  Google Scholar 

  9. Pleines UE, Morganti-Kossmann MC, Rancan M, et al. S-100 beta reflects the extent of injury and outcome, whereas neuronal specific enolase is a better indicator of neuroinflammation in patients with severe traumatic brain injury. J Neurotrauma. 2001;18:491–8.

    Article  CAS  PubMed  Google Scholar 

  10. Piazza O, Storti MP, Cotena S, et al. S100B is not a reliable prognostic index in paediatric TBI. Pediatr Neurosurg. 2007;43:258–64.

    Article  CAS  PubMed  Google Scholar 

  11. Anderson RE, Hansson LO, Nilsson O, et al. Increase in serum S100A1-B and S100BB during cardiac surgery arises from extracerebral sources. Ann Thorac Surg. 2001;71:1512–7.

    Article  CAS  PubMed  Google Scholar 

  12. Soul JS, du Plessis AJ. New technologies in pediatric neurology. Near-infrared spectroscopy. Semin Pediatr Neurol. 1999;6:101–10.

    Article  CAS  PubMed  Google Scholar 

  13. Zeltzer PM, Marangos PJ, Parma AM, et al. Raised neuron-specific enolase in serum of children with metastatic neuroblastoma. A report from the Children’s Cancer Study Group. Lancet. 1983;2:361–3.

    Article  CAS  PubMed  Google Scholar 

  14. Hsu AA, Fenton K, Weinstein S, et al. Neurological injury markers in children with septic shock. Pediatr Crit Care. 2008;9:245–51.

    Article  Google Scholar 

  15. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74.

    Google Scholar 

  16. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med. 1996;24:743–52.

    Article  CAS  PubMed  Google Scholar 

  17. Trachsel D, McCrindle BW, Nakagawa S, Bohn D. Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2005;172:206–11.

    Article  PubMed  Google Scholar 

  18. Rivera RA, Butt W, Shann F. Predictors of mortality in children with respiratory failure: possible indications for ECMO. Anaesth Intensive Care. 1990;18:385–9.

    CAS  PubMed  Google Scholar 

  19. Leteurtre S, Martinot A, Duhamel A, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet. 2003;362:192–7.

    Article  PubMed  Google Scholar 

  20. Shore PM, Berger RP, Varma S, et al. Cerebrospinal fluid biomarkers versus glasgow coma scale and glasgow outcome scale in pediatric traumatic brain injury: the role of young age and inflicted injury. J Neurotrauma. 2007;24:75–86.

    Article  PubMed  Google Scholar 

  21. Bandyopadhyay S, Hennes H, Gorelick MH, et al. Serum neuron-specific enolase as a predictor of short-term outcome in children with closed traumatic brain injury. Acad Emerg Med. 2005;12:732–8.

    Article  PubMed  Google Scholar 

  22. Petzold A, Keir G, Lim D, et al. Cerebrospinal fluid (CSF) and serum S100B: release and wash-out pattern. Brain Res Bull. 2003;61:281–5.

    Article  CAS  PubMed  Google Scholar 

  23. Pelinka LE, Bahrami S, Szalay L, et al. Hemorrhagic shock induces an S 100 B increase associated with shock severity. Shock. 2003;19:422–6.

    Article  CAS  PubMed  Google Scholar 

  24. Dimopoulou I, Korfias S, Dafni U, et al. Protein S-100b serum levels in trauma-induced brain death. Neurology. 2003;60:947–51.

    Article  CAS  PubMed  Google Scholar 

  25. Berger RP, Pierce MC, Wisniewski SR, et al. Neuron-specific enolase and S100B in cerebrospinal fluid after severe traumatic brain injury in infants and children. Pediatrics. 2002;109:E31.

    Article  PubMed  Google Scholar 

  26. Berger RP, Pierce MC, Wisniewski SR, et al. Serum S100B concentrations are increased after closed head injury in children: a preliminary study. J Neurotrauma. 2002;19:1405–9.

    Article  PubMed  Google Scholar 

  27. Gazzolo D, Marinoni E, Di Iorio R, et al. Measurement of urinary S100B protein concentrations for the early identification of brain damage in asphyxiated full-term infants. Arch Pediatr Adolesc Med. 2003;157:1163–8.

    Article  PubMed  Google Scholar 

  28. Berger RP, Adelson PD, Richichi R, Kochanek PM. Serum biomarkers after traumatic and hypoxemic brain injuries: insight into the biochemical response of the pediatric brain to inflicted brain injury. Dev Neurosci. 2006;28:327–35.

    Article  PubMed  CAS  Google Scholar 

  29. Schmitt B, Bauersfeld U, Schmid ER, et al. Serum and CSF levels of neuron-specific enolase (NSE) in cardiac surgery with cardiopulmonary bypass: a marker of brain injury? Brain Dev. 1998;20:536–9.

    Article  CAS  PubMed  Google Scholar 

  30. Kirshbom PM, Forbess JM, Kogon BE, et al. Cerebral near infrared spectroscopy is a reliable marker of systemic perfusion in awake single ventricle children. Pediatr Cardiol. 2007;28:42–5.

    Article  PubMed  Google Scholar 

  31. Gottlieb EA, Fraser CD Jr., Andropoulos DB, Diaz LK. Bilateral monitoring of cerebral oxygen saturation results in recognition of aortic cannula malposition during pediatric congenital heart surgery. Paediatr Anaesth. 2006;16:787–9.

    Article  PubMed  Google Scholar 

  32. Hayashida M, Kin N, Tomioka T, et al. Cerebral ischaemia during cardiac surgery in children detected by combined monitoring of BIS and near-infrared spectroscopy. Br J Anaesth. 2004;92:662–9.

    Article  CAS  PubMed  Google Scholar 

  33. Berens RJ, Stuth EA, Robertson FA, et al. Near infrared spectroscopy monitoring during pediatric aortic coarctation repair. Paediatr Anaesth. 2006;16:777–81.

    Article  PubMed  Google Scholar 

  34. Huang L, Ding H, Hou X, et al. Assessment of the hypoxic-ischemic encephalopathy in neonates using non-invasive near-infrared spectroscopy. Physiol Meas. 2004;25:749–61.

    Article  PubMed  Google Scholar 

  35. Kurth CD, Steven JL, Montenegro LM, et al. Cerebral oxygen saturation before congenital heart surgery. Ann Thorac Surg. 2001;72:187–92.

    Article  CAS  PubMed  Google Scholar 

  36. Petrova A, Mehta R. Near-infrared spectroscopy in the detection of regional tissue oxygenation during hypoxic events in preterm infants undergoing critical care. Pediatr Crit Care Med. 2006;7:449–54.

    Article  PubMed  Google Scholar 

  37. Bhutta AT, Ford JW, Parker JG, et al. Noninvasive cerebral oximeter as a surrogate for mixed venous saturation in children. Pediatr Cardiol. 2007;28:34–41.

    Article  PubMed  Google Scholar 

  38. Tortoriello TA, Stayer SA, Mott AR, et al. A noninvasive estimation of mixed venous oxygen saturation using near-infrared spectroscopy by cerebral oximetry in pediatric cardiac surgery patients. Paediatr Anaesth. 2005;15:495–503.

    Article  PubMed  Google Scholar 

  39. Yoxall CW, Weindling AM, Dawani NH, Peart I. Measurement of cerebral venous oxyhemoglobin saturation in children by near-infrared spectroscopy and partial jugular venous occlusion. Pediatr Res. 1995;38:319–23.

    CAS  PubMed  Google Scholar 

  40. Gopinath SP, Cormio M, Ziegler J, et al. Intraoperative jugular desaturation during surgery for traumatic intracranial hematomas. Anesth Analg. 1996;83:1014–21.

    Article  CAS  PubMed  Google Scholar 

  41. Gopinath SP, Robertson CS, Contant CF, et al. Jugular venous desaturation and outcome after head injury. J Neurol Neurosurg Psychiatr. 1994;57:717–23.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

Dr. Bell is funded by NIH (HD 044716).

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Authors and Affiliations

  1. Division of Critical Care Medicine, Children’s National Medical Center, Washington, DC, 20010, USA

    Anjali Subbaswamy, Angela A. Hsu, Steven Weinstein & Michael J. Bell

  2. Division of Pediatric Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, 6th Floor, Main Tower, Pittsburgh, PA, 15213, USA

    Michael J. Bell

Authors
  1. Anjali Subbaswamy
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  2. Angela A. Hsu
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  4. Michael J. Bell
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Correspondence to Michael J. Bell.

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Subbaswamy, A., Hsu, A.A., Weinstein, S. et al. Correlation of Cerebral Near-Infrared Spectroscopy (cNIRS) and Neurological Markers in Critically Ill Children. Neurocrit Care 10, 129–135 (2009). https://doi.org/10.1007/s12028-008-9122-7

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