Objective: Near-infrared spectroscopy (NIRS) measures cerebral oxygenation and could measure the risk of hypoxia or hyperoxia in infants with bronchopulmonary dysplasia (BPD). We lack normalized data for NIRS values in neonates. We sought normative values of NIRS and proposed that NIRS could better identify a safe oxygen flow rate compared to pulse oximetry (POX). Methods: This prospective cohort study compared POX and NIRS values in healthy infants in room air (n = 22) with BPD infants (n = 10) on oxygen (0.03, 0.06, 0.12 L/min). Results: In healthy infants, the average POX value was 97.8%, and NIRS was 78.24%. Time (% time) with hypoxia was similarly low using either POX or NIRS (3.5% and 1.4%). On oxygen, % time with hypoxemia was similarly low with both POX or NIRS (0.03 lpm: 2.35% POX and 0.01% NIRS; 0.06 lpm: 1.43% POX and 0.6% NIRS; 0.12lpm: 1.46% POX and 0.2% NIRS). In contrast, the potential hyperoxia %time was higher using POX compared to NIRS (96.5% vs 47.9%) in room air healthy infants. Similarly, hyperoxia %time was more common with POX compared to NIRS, but there was no difference with increasing oxygen flow rates (0.03 lpm, 82.13% POX and 41.5% NIRS; 0.06 lpm: 92.49% POX and 34.4% NIRS; 0.12 lpm: 87.00% POX and 34.8% NIRS). Conclusion: We did not see a dose response correlation between oxygen flow rate and time spent in the hyperoxemic range across different flow rates by POX or cerebral NIRS. We did not see a benefit of NIRS in setting home oxygen flow rates.
Conventional clinical practice in the neonatal intensive care unit (NICU) often fails to actively monitor the brain, relying on reactive strategies and imprecise risk indicators. The introduction of Near -Infrared Spectroscopy (NIRS) enhances current approaches to brain monitoring, offering non-invasive, real-time, continuous, and tissue -specific measures of oxygen saturation. NIRS leverages the physics of light to provide a comprehensive evaluation of oxygen delivery and consumption. This review covers the principles of NIRS, normative values for cerebral oximetry, and its applications in various clinical scenarios. Current clinical applications of NIRS span diverse areas, including intraventricular hemorrhage, white matter injury, anemia, congenital heart disease, and hypoxic-ischemic encephalopathy (HIE). NIRS demonstrates its potential in predicting and preventing adverse outcomes, particularly in optimizing cerebral oxygenation during cardiac surgery and guiding respiratory support in neonates. Key highlights of this review include the role of NIRS for the detection of cerebral hypoxia, even when other monitors do not show signs of clinical deterioration, a discussion of new methods for quantifying cerebral autoregulation and the connection to brain injury, and the potential utility NIRS monitoring offers for critically ill infants, such as those with congenital heart disease. The comprehensive insights provided by NIRS, if translated effectively into clinical practice, have the potential to improve the care and outcomes of neonates in the NICU.
"What we know is little, and what we are ignorant of is immense"; the last words of Laplace still apply to the diagnosis and management of the patent ductus arteriosus (PDA). Despite decades of research, we are searching for the right approach to care for patients with PDA. Nuances of myocardial structural changes and cardiopulmonary interactions with prolonged exposure to excess pulmonary blood flow have played an important role in decision-making. The availability of medical treatments with poor efficacy and, historically, surgical ligation as the only available definitive therapy further widened the gap between observation and definitive closure. As more extremely low birth weight neonates born at earlier gestational ages survive, we are faced with a population whose physiological immaturity and structural alignment of the myocardium predisposes them to myocardial dysfunction and dysregulated vascular tone. Therefore, it may be time to replace historical approaches with a more precise patient-centric therapeutic model. A comprehensive serial echocardiography assessment of the heart function, hemodynamic significance, and clinical context with respect to pulmonary insufficiency and gut perfusion aids the neonatologist in making PDA management decisions. A targeted approach balances risks and benefits of therapy, avoids treatment for infants likely to have early spontaneous closure, and limits prolonged exposure to the pathologic PDA shunt in high-risk infants. There is significant variability in the diagnosis and treatment of the PDA, both within and across centers. This review highlights the clinical obstacles contributing to the variability and illustrates the need for a standardized approach to PDA diagnosis and management.
Background: Seizure is an occurrence of sudden, paroxysmal, abnormal alteration in electrographic activity at any point from birth to the end of the neonatal period. However, little is known about the number of seizures and the associated factors in the study area. Therefore, this study aimed to estimate the number of seizures and associated factors in neonates admitted with birth asphyxia to the neonatal intensive care unit in the Northwest Amhara Region Comprehensive Specialized Hospitals, Northwest Ethiopia, in 2023. Methods: A multicenter institution -based retrospective follow-up study was conducted among 423 neonates who had a follow-up visit at Comprehensive Specialized Hospitals of Northwest Ethiopia from October 1, 2019, to January 30, 2023. by reviewing the charts of neonates with asphyxia registered from October 01, 2019, to January 30, 2023. A simple random sampling technique was used to select the study participants. Data were extracted using an abstraction sheet, entered into EPidata version 4.6.0.0, and exported to STATA version 14 for analysis. A negative binomial Poisson regression model was best fitted for both bi -variable and multivariable analyses. Results: The mean number of seizures was 5.4515 (95% CI], 5.164-5.738) per 28 -day follow-up period. Hypoglycemia (AIRR = 1.17, 95% CI = (1.06 1.28), intraventricular hemorrhage (AIRR = 1.16, 95% CI = 1.16 (1.06 1.26), stage two hypoxic-ischemic injury (AIRR=11,49, 95% CI =5.9 22.23), stage three hypoxic-ischemic injury (AIRR = 13.22, 95% CI = (6.80 25.68) were significant. Conclusions and Recommendations: The current study showed that the mean number of seizures in newborns with perinatal asphyxia was higher than that in newborns without perinatal asphyxia: Hypoglycemia, intraventricular hemorrhage, and hypoxicischemic injury in the second and third stages were significant factors in the occurrence of seizures.
Background: Low birth weight (LBW) neonates face a significantly higher risk of complications and mortality compared to those with normal birth weight. This risk is particularly pronounced in low-income countries, where access to quality health care and adequate nutrition is limited. However, there is insufficient data on mortality for LBW neonates while receiving parenteral feedings. Therefore, this study was aimed to investigate the incidence and determinants of mortality among admitted LBW neonates receiving parenteral feeding at Neonatal Intensive Care Units (NICUs) in selected hospitals in Addis Ababa. Methods: A prospective follow-up study was conducted in selected hospitals' NICU from March to June 2022. Data were collected using a structured questionnaire and checklist, and analyzed using STATA software. The assumption for survival analysis was assessed using Kaplan-Meier survival curves and a global test. Bi-variable and multivariable Cox regression analyses were performed to identify determinants of mortality. A p -value of less than 0.05 was used to declare as a significant predictor. Results: Two hundred eighty-nine neonates with their indexed mothers were enrolled for a total of 2242 days. During this follow-up time sixty-six neonates were died, making the incidence rate of mortality among LBW neonates 29.438 per 1000 person -day. Birth weight less than 1000 grams (AHR: 9.539; 95% CI: 2.272, 40.038), admission Apgar score of three or less (AHR: 5.894 95% CI: 1.320, 26.315), edematous malnutrition (AHR: 3.389; 95% CI: 1.355, 8.474) and not initiated trophic feeding (AHR: 7.324; 95% CI: 3.453, 15.532) were identified as a significant predictors for neonatal mortality. Conclusion: This study revealed a high incidence of mortality among low birth weight (LBW) neonates who received parenteral feeding. Furthermore, factors such as birth weight, trophic feeding initiation, low Apgar score, and edematous malnutrition were identified as predictors for mortality among LBW neonates who received enteral feeding. Therefore, future studies should prioritize optimizing enteral feeding practices and enhancing the quality of care provided to LBW neonates.
