Measurement of cerebral oxygenation in neonates after vaginal delivery and cesarean section using full-spectrum near infrared spectroscopy

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Abstract

To investigate whether or not the mode of delivery produces differences in cerebral oxygenation, cerebral hemoglobin oxygen saturation was measured using full-spectrum near infrared spectroscopy in 26 healthy term newborn infants immediately after birth. Infants in group 1 (n=20) were delivered vaginally, and those in group 2 (n=6) by elective cesarean section. Arterial oxygen saturation in the right hand was also measured simultaneously using a pulse oximeter. Changes in arterial oxygen saturation showed no significant difference between the two groups. The mean±S.D. of cerebral hemoglobin oxygen saturation in group 1 increased rapidly after birth, from 29±17% at 2 min to 68±6% at 8.5 min, followed by an almost constant value (66±7% at 15 min). In comparison, cerebral hemoglobin oxygen saturation in group 2 also increased rapidly until 8.5 min, but after this time decreased significantly to 57±5% at 15 min after birth. This indicates that the mode of delivery has a marked influence on cerebral oxygenation immediately after birth.

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)

  • J.E. Brazy et al.

    Noninvasive monitoring of cerebral oxygenation in preterm infants: preliminary observations

    Pediatrics

    (1985)
  • F.F. Buchvald et al.

    Measurement of cerebral oxyhaemoglobin saturation and jugular blood flow in term healthy newborn infants by near-infrared spectroscopy and jugular venous occlusion

    Biol. Neonate

    (1999)
  • C.E. Cooper et al.

    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.

    (1996)
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