CLINICAL VALIDATION OF TISSUE OXYGEN INDEX IN NEONATES (PRENATAL GROUP)

新生儿组织氧指数的临床验证（产前组）

• 批准号: 7717188
• 负责人: RICHARD A JONAS
• 金额: $ 1.88万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-12-01 至 2008-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7717188
• 关键词: Acute; Address; Admixture; Animal Model; Attention; Blood Circulation; Blood Vessels; Blood flow; Brain; Brain Injuries; Bypass; Cardiac Surgery procedures; Caring; Cerebrum; Clinical; Complex; Computer Retrieval of Information on Scientific Projects Database; Congenital Abnormality; Development; Disabled Persons; Ductus Arteriosus; Echocardiography; Fetal Growth Retardation; Fetus; Funding; Grant; Hand; Heart Diseases; Hypoxemia; Impairment; Indomethacin; Infant; Infant Care; Institution; Measurement; Medical; Methods; Monitor; Near-Infrared Spectroscopy; Nervous System Trauma; Neurodevelopmental Impairment; Neurologic Examination; Neurological status; Obstruction; Operative Surgical Procedures; Outcome; Oxygen; Patients; Perfusion; Premature Infant; Research; Research Personnel; Resistance; Resources; Risk; Role; Source; Subgroup; Theft; Time; Tissues; United States National Institutes of Health; Validation; Vasodilation; Venous; aortic arch; congenital heart disorder; fetal blood; handicapping condition; hemodynamics; improved; in utero; indexing; neonate; neurodevelopment; prenatal; vasoconstriction

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. Brain injury continues to be an important problem for high-risk neonates including premature infants <1000g and neonates undergoing complex cardiac surgery. Although manipulation of intraoperative factors can improve neurodevelopmental outcomes during cardiac surgery, further improvements are required for neonates with highly complex problems. In addition, premature infants continue to have significant neurodevelopmental abnormalities despite improvements in medical care. Studies by Dr. Jonas investigating neurological injury in infants with congenital heart disease have identified a subgroup of patients at risk for cerebral steal (shift of blood flow away from the brain due to a low resistance competing circuit) to be at risk for neurological injury when a cerebral vasoconstricting bypass strategy was introduced. Premature infants may be exposed to a cerebral steal from the ductus arteriousus and vasoconstriction from indomethacin therapy.The neurological examination during times of hemodynamic instability and operative procedures is difficult. Near Infrared Spectroscopy (NIRS) provides measurement of cerebral oxygenation and vascular reactivity that has been shown to correlate with acute neurological status and subsequent clinical outcomes. Until recently, a major limitation of NIRS has been an inability for real-time monitoring. Recent developments have addressed this limitation with the ability to make online calculations of the TOI. Dr. Jonas in an animal model has shown that TOI is a predictor of neurological injury and can be used to guide treatment to improve cerebral oxygenation. TOI has not been investigated in the clinical setting. In the current era, the majority of babies with heart disease are expected to survive surgery. A significant percentage of these infants have multiple handicaps, either related to associated birth defects, or to neurodevelopmental compromise. The issue at hand is to determine how much of the impairment is related to limited potential versus acquired damage. While significant attention has been directed towards the method of support during surgery, little attention has been directed at the role that altered oxygen delivery and blood flow attending the abnormal circulation in fetuses with heart disease may have on brain development. Autoregulatory changes in fetal blood flow distribution which directs more blood flow to the brain by cerebral vasodilation has been termed "brain sparing" and is a predictor of neurodevelopmental impairment in fetuses with intrauterine growth restriction or uteroplacental abnormalities. These flow distribution have been correlated with poor outcome and abnormalities in neurodevelopment. The identification of the predictors of impaired neurodevelopmental potential due to in-utero factors, versus those caused by acquired damage, is fundamental to the care of infants with congenital heart disease. Dr. Donofrio has demonstrated that brain sparing occurs in fetuses with complex congenital heart disease. Alterations in blood flow were reliably identified by echocardiography. Redistribution of blood flow toward the brain occurred in fetuses with systemic arterial hypoxemia caused by complete venous admixture, or limited systemic arterial perfusion caused by obstruction to antegrade aortic perfusion with retrograde perfusion of the aortic arch from the ductus arteriosus. How these alterations effect cerebral oxygenation in-utero and neurodevelopmental outcome has yet to be determined.

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。 对于高风险的新生儿，包括早产婴儿和接受复杂心脏手术的新生儿，脑损伤仍然是一个重要的问题。 尽管操纵术中因素可以改善心脏手术期间神经发育的结局，但具有高度复杂问题的新生儿需要进一步改善。 此外，尽管医疗保健方面有所改善，但早产婴儿仍有明显的神经发育异常。乔纳斯（Jonas）博士研究了先天性心脏病的婴儿神经损伤的研究已经确定了一个有脑窃取风险的患者（由于低阻力竞争电路，血液流从大脑移开）是在介绍神经系统损伤的风险时，当引入了脑部加剧旁路旁路策略时。早产婴儿可能会暴露于大动脉导管中的脑窃取和血管收缩，并受到吲哚美辛疗法的血管收缩。在血液动力学不稳定和手术过程的时期，神经系统检查很困难。近红外光谱法（NIRS）提供了脑充氧和血管反应性的测量，这些反应与急性神经系统状况和随后的临床结果相关。直到最近，NIRS的主要局限性一直无法进行实时监控。最近的发展已经解决了这一限制，能够对TOI进行在线计算。 乔纳斯博士在动物模型中表明，TOI是神经损伤的预测指标，可用于指导治疗以改善脑充氧。 TOI尚未在临床环境中进行研究。 在当前时代，大多数患有心脏病的婴儿有望在手术中生存。 这些婴儿中有很大一部分具有多个障碍，要么与相关的先天缺陷或神经发育妥协有关。手头的问题是确定有限的损害与有限的潜在损害相对于获得的损害。 尽管在手术过程中已引起了很大的关注，但很少关注氧气递送和血液流量的作用，而患有心脏病的胎儿循环异常可能会对脑发育产生。 胎儿血流分布的自动调节性变化通过脑血管舒张引导流向大脑的更多血流已被称为“脑部保留”，并且是胎儿内生长限制或子宫牙科异常的胎儿神经发育障碍的预测指标。这些流量分布与神经发育的预后和异常相关。由于因子内因因素而导致的神经发育潜力受损的预测因素，而被收购损害引起的预测因素对于先天性心脏病的婴儿的护理至关重要。 Donofrio博士证明，脑保存发生在患有复杂先天性心脏病的胎儿中。通过超声心动图可靠地鉴定出血流的改变。 血液流向大脑的重新分布发生在胎儿中发生，由完全静脉混合物引起的全身性动脉低氧血症，或者是由于逆转性主动脉灌注而引起的有限的全身动脉灌注，并从动脉内部的主动脉弓逆转灌注。这些变化如何影响脑充氧于utero和神经发育结果尚未确定。