Measurement of cerebral oxygenation in neonates after vaginal delivery and cesarean section using full-spectrum near infrared spectroscopy☆
Introduction
Human neonates adapt to life in the extrauterine environment by passing through the dramatic environmental change we call birth. As expressed in the well-known phrase ‘Mt. Everest in utero’, (Eastman, 1954) the extremely low partial pressure of oxygen in fetuses (20–25 mmHg) compared with adult humans rises dramatically at the time of birth. Oxygen saturation also changes dynamically. Almost without exception, the transition to pulmonary breathing at birth occurs without impediment in term infants, who are able to adapt smoothly from intrauterine to extrauterine life. In the case of hypoxic–ischemic encephalopathy resulting from asphyxia neonatorum, however, adaptation of the circulatory and respiratory systems do not occur smoothly at birth. Thus, because of the possibility of permanent central nervous damage, the evaluation of postnatal cerebral circulation and oxygenation dynamics is essential.
In 1977, Jöbsis (1977) was the first to report measuring the oxygenation of hemoglobin and the redox state of cytochrome c oxidase in tissues as changes in the absorption spectrum in the near infrared region. Since that time, near infrared spectroscopy has been widely regarded as non-invasive, and has been applied in the clinical field with various measuring devices using several wavelengths (Brazy et al., 1985, Wyatt et al., 1986, Chance et al., 1988, Edwards et al., 1988, Edwards et al., 1990, Pryds et al., 1990, Peebles et al., 1992a, Kato et al., 1993, Meek et al., 1999). However, research on changes in cerebral oxygenation immediately after birth is limited to only two reports: one by Peebles et al. (1992b), and our own preliminary investigation (Isobe et al., 2000).
In the present study, full-spectrum near infrared spectroscopy (fsNIRS) was used for real time measurements of the postnatal changes in cerebral hemoglobin oxygen saturation (SbO2) that occur in term infants delivered vaginally or by elective cesarean section. The changes that occur with time were investigated with reference to the mode of delivery.
Section snippets
Materials and methods
The subjects were 26 term infants born at the Maternal and Children's Center of Kagawa Medical University Hospital. The 20 infants in group 1 were delivered vaginally and the six infants in group 2 were delivered by elective cesarean section. None of the neonates required resuscitation. The gestational weeks of the subject neonates were 37–41 weeks, and their Apgar scores at 1 min were 6 or above. Informed consent for the measurements was obtained from the parents of all of the infants. The
Results
A comparison of the infants’ physiologic data is shown in Table 1. There was no significant difference between the groups in birth weight, Apgar score, or cord blood gases.
As shown in Fig. 1, the mean±S.D. of SbO2 in the vaginal delivery group rose rapidly from 29±17% at 2 min postpartum to 68±6% at 8.5 min postpartum, after which it remained almost steady, showing a value of 66±7% at 15 min. A similar rise was observed in the cesarean group, with the mean±S.D. of SbO2 rising from a value of
Discussion
New NIRS methods have been used recently in clinical trials to directly measure oxygen saturation in tissue. These methods include time-resolved spectroscopy, spatially resolved spectroscopy, and frequency domain spectroscopy. Although there have been reports regarding hemoglobin oxygen saturation in muscle (Oda et al., 1999, Suzuki et al., 1999) and brain tissue (Quaresima et al., 2000) in human adults, the only two reports on cerebral oxygen saturation in neonates are one by Cooper et al.
Acknowledgements
This research was supported by Grants-in-Aid for Scientific Research (B) Nos. 05557055, 11470221, (C) Nos. 09671194 and 11671070, and Encouragement of Young Scientists No. 11770614 from the Ministry of Education of Japan (Science and Culture Division).
References (26)
- et al.
Time-resolved spectroscopy of hemoglobin and myoglobin in resting and ischemic muscle
Anal. Biochem.
(1988) - et al.
Cotside measurement of cerebral blood flow in ill newborn infants by near infrared spectroscopy
Lancet
(1988) - et al.
Effects of indomethacin on cerebral haemodynamics in very preterm infants
Lancet
(1990) - et al.
Sympathoadrenal activity and peripheral blood flow after birth: comparison in infants delivered vaginally and by cesarean section
J. Pediatr.
(1984) - et al.
Pulse oxygen saturation and neurologic assessment in human neonates after vaginal and cesarean delivery
Int. J. Gynecol. Obstet.
(1998) - et al.
Changes in arterial oxygen saturation immediately after birth in the human neonate
J. Pediatr.
(1986) - et al.
Changes in human fetal cerebral hemoglobin concentration and oxygenation during labor measured by near-infrared spectroscopy
Am. J. Obstet. Gynecol.
(1992) - et al.
Changes in human fetal cerebral oxygenation and blood volume during delivery
Am. J. Obstet. Gynecol.
(1992) - et al.
Quantification of cerebral oxygenation and haemodynamics in sick newborn infants by near infrared spectrophotometry
Lancet
(1986) - et al.
Hemodynamic adaptations at birth and neonates delivered vaginally and by cesarean section
Biol. Neonate
(1995)
Noninvasive monitoring of cerebral oxygenation in preterm infants: preliminary observations
Pediatrics
Measurement of cerebral oxyhaemoglobin saturation and jugular blood flow in term healthy newborn infants by near-infrared spectroscopy and jugular venous occlusion
Biol. Neonate
The noninvasive measurement of absolute cerebral deoxyhemoglobin concentration and mean optical path length in the neonatal brain by second derivative near infrared spectroscopy
Pediatr. Res.
Cited by (46)
Near-infrared spectroscopy in the medical management of infants
2022, Current Problems in Pediatric and Adolescent Health CareCitation Excerpt :Although arterial oxygen saturation and CrSO2 both increase rapidly over the first few minutes of life, CrSO2 reaches a plateau faster potentially indicating preferential delivery of oxygen to the brain in the first minutes of life.52,61 Additionally, while arterial oxygen saturation is affected by the mode of delivery, CrSO2 is not.51 Other studies have shown that infants requiring respiratory support during the immediate transition do not achieve the same level of CrSO2 as those who do not require support and have an increased cerebral FTOE.62,63
Cerebral, renal and mesenteric regional oxygen saturation of term infants during transition
2015, Journal of Pediatric SurgeryCitation Excerpt :Based on the principle of different absorbency patterns of near-infrared light by oxyhemoglobin and deoxyhemoglobin, NIRS measures the rSO2 which, in combination with the SpO2, allows for calculation of tissue oxygen extraction in the target organs. So far, many studies have investigated the changes in cerebral tissue oxygenation occurring during the adaptation from intrauterine to extra-uterine life in healthy term infants [7–10]. Nevertheless, there are no previous studies assessing the adaptive changes of “non-vital” organs, such as kidneys and mesenteric tissue in the immediate transitional period.
Cerebral blood volume measurement using near-infrared time-resolved spectroscopy and histopathological evaluation after hypoxic-ischemic insult in newborn piglets
2015, International Journal of Developmental NeuroscienceCitation Excerpt :Monitoring very early changes in the CBV from immediately after birth of asphyxic neonates would help differentiate the severity of brain damage. As reports on changes in the cerebral circulation from immediately after birth and during resuscitation using NIRS have been increasing in number recently, vigilant and intensive evaluation using NIRS from immediately after birth is recommended for babies suspected of having been exposed to hypoxia in utero (Binder et al., 2013; Isobe et al., 2002; Pichler et al., 2013a, b). In our newborn piglet model, data were obtained continuously during the hypoxic insult.
Cesarean under general or epidural anesthesia: Does it differ in terms of regional cerebral oxygenation?
2014, Acta Anaesthesiologica TaiwanicaEvaluation of cerebral circulation and oxygen metabolism in infants using near-infrared light
2014, Brain and Development
- ☆
This paper was presented as part of ISOTT2000 held in Nijmegen, The Netherlands, August 20–25, 2000. The Organizer was Dr Berend Oeseburg.