Source:Pediatric Neurology
Author(s): Michael Kochan, Jacob McPadden, W. Thomas Bass, Tushar Shah, Wendy T. Brown, Gary W. Tye, Turaj Vazifedan
BackgroundOptimal timing of intervention in neonatal progressive posthemorrhagic hydrocephalus is often a difficult decision. Unchecked hydrocephalus can lead to irreversible brain injury through impaired perfusion, while placement of a shunt is not without long term morbidity. The purpose of this study was to assess the use of near-infrared spectroscopy to measure changes in regional cerebral oxygen saturation as an indicator of cerebral perfusion in infants with progressive posthemorrhagic ventricular dilation.MethodsNear-infrared spectroscopy was used to measure regional cerebral oxygen saturation over a one-hour period in infants within 24-hours of cranial ultrasound. Simultaneous pulse oximetry was recorded and oxygen extraction was calculated. Ventricular size was measured from ultrasound using the frontal-occipital horn ratio and compared to average oxygen saturation and oxygen extraction. Statistical analysis was done using the Spearman rank test and ANOVA.ResultsVentricular measurements were made in 20 very low birth weight premature infants with periventricular-intraventricular hemorrhage and 12 infants with normal ultrasound scans. Ventricular dilation was associated with lower cerebral oxygen saturation and higher oxygen extraction (p < 0.001). Progressive ventricular dilation was inversely related to changes in cerebral oxygen saturation (p < 0.001).ConclusionsProgressive posthemorrhagic ventricular dilation is associated with a significant decrease in cerebral oxygenation and increase in oxygen extraction suggesting a decrease in cerebral perfusion. Near-infrared spectroscopy could potentially provide additional clinical information to assist in determining optimal timing of surgical intervention in premature infants with progressive ventricular enlargement.
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