End-organ saturations correlate with aortic blood flow estimates by echocardiography in the extremely premature newborn - an observational cohort study

Gabriel Altit, Shazia Bhombal, Valerie Y Chock, Gabriel Altit, Shazia Bhombal, Valerie Y Chock

Abstract

Background: Near-infrared spectroscopy (NIRS) measures of cerebral saturation (Csat) and renal saturation (Rsat) in extreme premature newborns may be affected by systemic blood flow fluctuations. Despite increasing clinical use of NIRS to monitor tissue saturation in the premature infant, validation of NIRS measures as a correlate of blood flow is still needed. We compared echocardiography (ECHO) derived markers of ascending aorta (AscAo) and descending aorta (DesAo) blood flow with NIRS measurements obtained during the ECHO.

Methods: Newborns < 29 weeks' gestation (2013-2017) underwent routine NIRS monitoring. Csat, Rsat and systemic saturation at the time of ECHO were retrospectively analyzed and compared with Doppler markers of aortic flow. Renal and cerebral fractional tissue oxygen extraction (rFTOE and cFTOE, respectively) were calculated. Mixed effects models evaluated the association between NIRS and Doppler markers.

Results: Forty-nine neonates with 75 Csat-ECHO and 62 Rsat-ECHO observations were studied. Mean post-menstrual age was 28.3 ± 3.8 weeks during the ECHO. Preductal measures including AscAo velocity time integral (VTI) and AscAo output were correlated with Csat or cFTOE, while postductal measures including DesAo VTI, DesAo peak systolic velocity, and estimated DesAo output were more closely correlated with Rsat or rFTOE.

Conclusions: NIRS measures are associated with aortic blood flow measurements by ECHO in the extremely premature population. NIRS is a tool to consider when following end organ perfusion in the preterm infant.

Trial registration: ClinicalTrials.gov NCT04106479.

Keywords: Echocardiography, aortic blood flow; Extreme prematurity; Near infrared spectroscopy; Regional saturation.

Conflict of interest statement

Gabriel Altit obtained a material grant (consisting of NIRS monitors and sensors) by Medtronic via their peer-review grant program for a study for which he is the principal investigator (

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Pulse-wave Doppler envelopes in the Aorta. Legend: Peak systolic velocity and velocity time integral of the spectral envelope obtained by pulse-wave Doppler at various level in the Aorta. Panel a: Ascending aorta in the suprasternal view; b: Descending Aorta in the subcostal view (retrograde flow in diastole); c Post-ductal descending aorta in the suprasternal view (anterograde flow in diastole); d Post-ductal descending aorta in the suprasternal view (retrograde flow in diastole)
Fig. 2
Fig. 2
Unadjusted Linear Regression with descending aorta VTI in suprasternal view. Legend: Unadjusted linear regression indicating a correlation between Rsat and rFTOE with post-ductal descending Aortic VTI, as well as with Csat and cFTOE

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