ASSESSING GUT OXYGENATION IN PREMATURE INFANTS USING NEAR INFRARED SPECTROMET

使用近红外光谱仪评估早产儿肠道氧合情况

• 批准号: 8166678
• 负责人: OLUYINKA OLUROTIMI OLUTOYE
• 金额: $ 0.81万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2010-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8166678
• 关键词: Acute Abdomen; Analgesics; Apnea; Birth; Blood; Bradycardia; Brain; Cerebrum; Characteristics; Child; Clinical; Comorbidity; Computer Retrieval of Information on Scientific Projects Database; Data; Development; Disease; Due Process; Etiology; Feeds; Funding; Future; Grant; Hemoglobin; Hypotension; Incidence; Infant; Institution; Intestinal Diseases; Intestines; Light; Measurement; Measures; Near-Infrared Spectroscopy; Necrotizing Enterocolitis; Newborn Infant; Normal Range; Oral; Oxygen; Oxyhemoglobin; Perfusion; Peripheral; Physiologic pulse; Population; Premature Infant; Process; Publishing; Research; Research Personnel; Resources; Risk; Side; Signal Transduction; Source; Time; Tissues; United States National Institutes of Health; Venous; absorption; adverse outcome; capillary bed; deoxyhemoglobin; falls; feeding; indexing; intraventricular hemorrhage; neonate; oxidation; patient population; respiratory; respiratory distress syndrome; sedative; standard of care

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Infants who have lower measures of gut oxygenation (compared to brain) are more likely to develop Necrotizing enterocolitis (NEC) or other intestinal disease and to have feeding intolerance. The primary objective of this project is to establish a baseline for normal values of NIRS measurements in premature infants and to establish what changes exist, if any with feeding. Because the incidence of NEC is around 5% in this patient population, we will be able to generate some pilot data on the usefulness of NIRS in predicting NEC. I. To obtain "normal" intestinal tissue oxidation index values (TOI) in newborns weighing 750 to 1500g. 2. To obtain a cerebro-splanchnic oxgenation ration (CSOR) for each child in order to compare values at separate time points (at 1,2,3, and 4 weeks after birth). 3. To correlate decreasing CSOR and TOI with the development of NEC or other intestinal disease, if it occurs. 4. To obtain "normal" values of increased intestinal TOI during feeding at 1,2,3, and 4 weeks after birth. 5. To correlate a blunted intestinal TOI increase with feeding with the onset of feeding intolerance, if it occurs. Premature infants are at risk for neurodevelopmental adverse outcomes from a number of causes, including hypotoxic-ischemic insults from the delivery process, respiratory distress syndrome, intraventricular hemorrhage, sedative and analgesic drugs, and apnea/bradycardia. In addition, premature infants frequently develop necrotizing enterocolitis (NEC), the etiology of which is still unclear, but may be related to decreased gut perfusion. Near-infrared spectroscopy (NIRS) measures cerebral and somatic oxygenation with two wavelengths of light to which oxy-and deoxyhemoglobin have distinct absorption characteristics. The oxyhemoglobin and total hemoglobin signals are measured, and a regional cerebral or intestinal oxyhemoglobin saturation ratio is calculated (tissue oxidation index, or TOI). Low intestinal TOI may help explain the high incidence of necrotizing enterocolitis in this population. Cerebral perfusion is autoregulated, therefore, a splanchnic: cerebral perfusion ratio should remain constant under normal conditions, but should be expected to fall during hypotension or sschemia. A recently published study showed a significant difference between the brain/gut ratio of TOI between neonates with NEC/acute abdomen and those without. However, there is no data to prove that a decreasing ration predicts these problems (i.e., is the decrease in gut perfusion as a result of the disease process, or is the disease process due to the decrease in gut perfusion?). As mentioned in our specific aims, obtaining normal values are critical for future studies. Without any data, it is difficult to speculate, but the ideal clinical situation would be to establish a "cut off" point. Put in different terms, what we hope we will find is a number that defines abnormal gut perfusion and predicts feeding intolerance. The numbers will be presented as real values, which the machine expresses as percentage StO2. This value represents the percentage of oxygenated hemoglobin divided by the total hemoglobin. As this value is measured on the venous side of the capillary bed, it reflects blood oxygenation status after tissue oxygen extraction. The StO2 (5) will be compared to SPO2 (%) of the peripheral pulse oximeter (arterial side of peripheral capillary bed), as well as any ABGs that have been drawn per standard of care (if any). These vlaues will be examined with respect to oral feeds, respiratory rate, and any oxygenation and perfusion co-morbidities.

该副本是利用众多研究子项目之一 由NIH/NCRR资助的中心赠款提供的资源。子弹和 调查员（PI）可能已经从其他NIH来源获得了主要资金， 因此可以在其他清晰的条目中代表。列出的机构是 对于中心，这不一定是调查员的机构。 具有较低肠道氧合（与大脑相比）量度较低的婴儿更有可能发展坏死性小肠结肠炎（NEC）或其他肠道疾病并具有不耐受性。 该项目的主要目的是为早产儿中NIRS测量的正常值建立基线，并确定存在哪些变化（如果有进食）。 由于该患者人群中NEC的发病率约为5％，因此我们将能够生成有关NIR预测NEC有用性的一些试点数据。 I.在重750至1500G的新生儿中获得“正常”肠道组织氧化指数值（TOI）。 2。为了获得每个孩子的脑植物氧化量（CSOR），以比较在单独的时间点（在1,2,3和出生后4周）比较值。 3。将CSOR和TOI与NEC或其他肠道疾病的发展相关联。 4。在1,2,3和出生后4周时，在进食过程中获得增加的肠道TOI的“正常”值。 5。为了将钝的肠TOI与喂食与喂养不耐受的发作相关联（如果发生）。 过早的婴儿有多种原因的神经发育不良结果的风险，包括递送过程中的低毒性 - 缺血性损伤，呼吸窘迫综合征，脑室出血，镇静性和镇痛药，以及呼吸暂停/呼吸暂停。 此外，早产婴儿经常出现坏死性小肠结肠炎（NEC），其病因仍然不清楚，但可能与肠道灌注降低有关。 近红外光谱法（NIRS）测量了两个波长的脑氧合，氧气和脱氧血红蛋白具有独特的吸收特征。 测量氧气血红蛋白和总血红蛋白信号，并计算区域大脑或肠道氧气血红蛋白饱和度比（组织氧化指数或TOI）。 低肠道TOI可能有助于解释该人群中坏死性小肠结肠炎的高发病率。 因此，脑灌注受到自动调节，因此，在正常情况下应保持斑点：脑灌注比应保持恒定，但应预期在低血压或sschemia期间下降。 最近发表的一项研究表明，NEC/急性腹部的新生儿与没有的NEONANES之间的大脑/肠道比率存在显着差异。 但是，没有数据可以证明降低的口粮可以预测这些问题（即，由于疾病过程而导致的肠道灌注会减少，还是由于肠道灌注的减少而引起的疾病过程？）。 如我们的特定目标中所述，获得正常值对于将来的研究至关重要。 没有任何数据，很难推测，但是理想的临床情况是建立一个“切断”点。 简而言之，我们希望我们能找到的是一个定义异常肠道灌注并预测喂养不耐受的数字。 数字将作为真实值表示，机器表示为sto2百分比。 该值代表氧化血红蛋白的百分比除以总血红蛋白。 由于该值是在毛细管床的静脉侧测量的，因此它反映了提取氧气后的血液氧合状态。 将STO2（5）与SPO2（％）进行比较，外周脉冲血氧仪（外围毛细血管床的动脉侧），以及每个根据护理标准（如果有）绘制的ABG。 这些vlaues将在口服饲料，呼吸速率以及任何氧合和灌注合并症方面进行检查。