Einfluss von Sättigungsabfällen und Bradykardien bei Frühgeborenen auf die zerebrale Oxygenierung: eine Cross-Over-Studie von zwei unterschiedlichen Sättigungszielbereichen
InstitutionsUKU. Klinik für Kinder- und Jugendmedizin
UKU. Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung
Apnea of prematurity is a common problem in preterm infants. There is some evidence that a higher arterial oxygen saturation target might reduce the incidence and severity of apneic spells and desaturations. Little is known about influence of oxygen saturation target on cerebral oxygenation in preterm infants. To evaluate whether a higher arterial oxygen saturation target is associated with reduced incidence and severity of cerebral tissue oxygen desaturations. In 16 preterm infants with severe apnea of prematurity cerebral tissue oxygen saturation, fractional tissue oxygen extraction, arterial oxygen saturation and heart rate were recorded simultaneously. Cerebral tissue oxygen saturation was measured by near infrared spectroscopy with a laser light source utilizing 4 different wavelengths. In a randomized cross-over design arterial oxygen target was set to 80-92% for 4 hours and 85-96% for another 4 hours. On a subsequent day the recording was repeated in inverse sequence. Primary outcome measure was the cumulative cerebral tissue oxygen desaturation, defined as the calculated cerebral desaturation score representing the area below the baseline value before onset of each apneic spell. Results during low arterial oxygen saturation target as compared to high target, cerebral desaturation scores were significantly higher (27384 vs 18103), median number of events was higher (29,1 vs 21,1) and more time was spent with arterial oxygen saturation below 80% (57.2 minutes vs. 34.0 minutes, p 0.006) and 75% (22.7 minutes vs. 13.9 minutes, p 0.018), respectively. Total time of hyperoxia defined as arterial oxygen saturation ≥ 97% and ≥ 99%, respectively, nor total time with cerebral tissue oxygen saturation ≤ 65%, ≤ 60%, ≤ 55%, respectively, differed significantly between both target rangess. A lower arterial oxygen saturation target range (80-92%) as compared with a higher target range (85-96%) was associated with more arterial oxygen desaturation spells (<80% and <75%, respectively) and with more cerebral tissue oxygen desaturations. However total time with low cerebral tissue oxygen saturation was not affected. The influence of arterial oxygen saturation target ranges on cerebral tissue oxygenation needs further evaluation.
Subject HeadingsNIR-Spektroskopie [GND]
Spectroscopy, Near-infrared [MeSH]
Infant, Premature [MeSH]
Infant, Extremely premature [MeSH]