Abstract
Amaç: Neonatal hipoglisemi (NH) yenidoğan pratiğinde sık karşılaşılan bir durumdur. Bu çalışma ile doğumdan sonra NH gelişen yenidoğanlarda yaşamın ilk saatlerindeki serebral doku oksijenasyonu ve serebral kan akımının değerlendirilmesi amaçlanmıştır.
Yöntem: Prospektif yürütülen çalışmaya doğumdan sonra NH gelişen (n=50) ve gelişmeyen (n=50) yenidoğan bebekler dahil edildi. Her iki gruptaki bebeklerde yaşamın ilk 24 saati boyunca near-infrared spectroscopy (NIRS) ile devamlı bölgesel serebral doku oksijenasyonu (rcSO2 ) ölçüldü. Yaşamın ilk saati ve 24.saatinde bebeklerin orta serebral arter (MCA) kan akımları Doppler ultrasonografi ile değerlendirildi. NH gelişen ve gelişmeyen gruplar karşılaştırıldı.
Bulgular: Bebeklerin ortalama gebelik haftası, doğum ağırlıkları ve hemoglobin düzeyleri benzerdi. NH gelişen ve gelişmeyen bebekler karşılaştırıldığında NH gelişen bebeklerde ortalama rcSO2 değerleri anlamlı yüksek ve fraksiyone doku oksijen ekstraksiyon (FTOE) değerleri anlamlı düşük bulundu. Yaşamın ilk saatinde ve 24. saatinde ölçülen, vasküler direnci gösteren serebral doppler indeksleri (Pulsatilite indeksi:PI) de NH gelişen grupta anlamlı olarak yüksekti.
Sonuç: Bu çalışma ile NH gelişen yenidoğanlarda serebral dolaşımın ve oksijenasyonun bozulduğu gösterilmiştir. Hipoglisemi gelişen grupta yüksek ölçülen PI, serebral vasküler direncin arttığını göstermektedir. Bu grupta yüksek ölçülen rcSO2 değerlerinin azalmış serebral akımı kompanse etmek için gelişen serebral otoregülasyon sonucu geliştiği düşünülmektedir. FTOE düzeylerinin düşük olması ise serebral otoregülasyon mekanizmalarına rağmen NH’de serebral dolaşımın ve serebral oksijenasyonun bozulduğunu düşündürmüştür. Bu nedenle asemptomatik olsalar dahi NH gelişen bebeklerin uzun dönem nörolojik gelişimlerinin takip edilmesi gerekmektedir.
Supporting Institution
yok
References
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- Adamkin DH, and committee on fetus and newborn. Postnatal glucose homeostasis in late preterm and term infants. Pediatrics. 2011;127(3):575-579. google scholar
- Schwaberger B, Pichler G, Binder-Heschl C, Baik N, Avian A, Urlesberger B. Transitional changes in cerebral blood volume at birth. Neonatology. 2015;108:253-258. google scholar
- Pichler G, Cheung PY, Aziz K, Urlesberger B, Schmolzer GM: How to monitor the brain during immediate neonatal transition and resuscitation? A systematic qualitative review of the literature. Neonatology. 2014;105:205-210. google scholar
- Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J. Pulsatility Index determination by flowmeter measurement: a new indicator for vascular resistance? Eur Surg Res. 2004;36:345-349. google scholar
- Aliefendioglu D, Coban A, Hatipoglu N, Ecevit A, Arısoy AE, Mutlu GY et al. Turkish Neonatology Society Diagnosis and Treatment Guidelines, Neonatal Hypoglycemia. 2019. google scholar
- Volpe JJ (2001). Hypoglycemia and Brain Injury. In: Volpe JJ, ed. Neurology of the Newborn. 4th ed. Philadelphia, PA. Saunders, pp:497-520. google scholar
- Boluyt N, van Kempen A, Offriga M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics. 2006:117:2231-2243. google scholar
- Kaiser JR, Bai S, Gibson N, Holland G, Lin TM, Swearingen CJ, et al. Association between transient newborn hypoglycemia and fourth grade achievement test proficiency: A population based study. JAMA Pediatr. 2015;169:913-921. google scholar
- Shah R, Harding J, Brown J, McKinlay C. Neonatal Glycemia and Neurodevelopmental Outcomes: A systematic Review and Meta-Analysis. Neonatology. 2019;115:116-126. google scholar
- Pryds O, Edwards A D. Cerebral blood flow in the newborn infant. Arch Dis Child Fetal Neonatal Ed. 1996;74:F63-F69. google scholar
- Vannucci CR, Vannucci. SJ Hypoglycemic brain injury. Semin Neonatal. 2001;6:147-155. google scholar
- Bozzetti V, Paterlini G, van Bel F, Visser GHA, Tosetti L, Gazzolo D, et al. Cerebral and somatic NIRS- determined oxygenation in IUGR preterm infants during transition. J Matern Fetal Neonatal Med. 2016;29:443-446. google scholar
- Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after asymptomatic neonatal hypoglycemia. Pediatrics. 2008;122(1):65-74. google scholar
- Kinnala A, Rikalainen H, Lapinleimu H, Parkkola R, Kormano M, Kero P. Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 1999;103(4 Pt 1):724-729. google scholar
- Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. BMJ. 1998;297(66-59):1304-1308. google scholar
- McKinlay CJD, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of neonatal hypoglycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171(19):972-983. google scholar
Abstract
Purpose: Neonatal hypoglycemia (NH) is frequent in neonatology practice. This study aimed to evaluate the regional cerebral tissue oxygenation and cerebral blood flow in neonates who developed NH immediately after birth.
Methods: This prospective study included infants who developed NH (n=50) and the control healthy term neonates (n=50). Infants with NH are monitored in terms of continuous regional cerebral tissue oxygenation (rcSO2 ) via near-infrared spectroscopy (NIRS) during the first 24 hours of life. Middle cerebral artery (MCA) blood flow was evaluated by doppler ultrasound at the first and 24 hours of life. The pulsatility index (PI) was measured to assess cerebral vascular resistance.
Results: The mean gestational age, birth weights and hemoglobin levels of infants were similar. The mean rcSO2 was continuously higher and fractional tissue oxygen extraction (FTOE) was lower in infants with NH. The mean MCA PI values at the first and 24th hours of life were significantly higher in NH.
Conclusions: This study shows that cerebral perfusion was impaired in infants with NH. They had higher rcSO2 , lower FTOE values and increased PI compared to healthy term infants. We suggest that increased PI may reflect increased vascular resistance and higher rcSO2 values associated with increased cerebral perfusion as a compensatory auto-regulatory response mechanism. Significantly lower FTOE values may dedicate decreased cerebral tissue oxygen extraction resulting from impaired cerebral perfusion even in the presence of auto-regulatory mechanisms. Therefore, even if they are asymptomatic, long term neurological outcomes should be followed in infants with NH due to impaired cerebral perfusion.
References
- Chandran S, Rajadural VS, Haium AAA, Hussain Khalid. Current perspectives on neonatal hypoglycemia, its management, and cerebral injury risk. Dovepress. 2015;5:17-30. google scholar
- Adamkin DH, and committee on fetus and newborn. Postnatal glucose homeostasis in late preterm and term infants. Pediatrics. 2011;127(3):575-579. google scholar
- Schwaberger B, Pichler G, Binder-Heschl C, Baik N, Avian A, Urlesberger B. Transitional changes in cerebral blood volume at birth. Neonatology. 2015;108:253-258. google scholar
- Pichler G, Cheung PY, Aziz K, Urlesberger B, Schmolzer GM: How to monitor the brain during immediate neonatal transition and resuscitation? A systematic qualitative review of the literature. Neonatology. 2014;105:205-210. google scholar
- Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J. Pulsatility Index determination by flowmeter measurement: a new indicator for vascular resistance? Eur Surg Res. 2004;36:345-349. google scholar
- Aliefendioglu D, Coban A, Hatipoglu N, Ecevit A, Arısoy AE, Mutlu GY et al. Turkish Neonatology Society Diagnosis and Treatment Guidelines, Neonatal Hypoglycemia. 2019. google scholar
- Volpe JJ (2001). Hypoglycemia and Brain Injury. In: Volpe JJ, ed. Neurology of the Newborn. 4th ed. Philadelphia, PA. Saunders, pp:497-520. google scholar
- Boluyt N, van Kempen A, Offriga M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics. 2006:117:2231-2243. google scholar
- Kaiser JR, Bai S, Gibson N, Holland G, Lin TM, Swearingen CJ, et al. Association between transient newborn hypoglycemia and fourth grade achievement test proficiency: A population based study. JAMA Pediatr. 2015;169:913-921. google scholar
- Shah R, Harding J, Brown J, McKinlay C. Neonatal Glycemia and Neurodevelopmental Outcomes: A systematic Review and Meta-Analysis. Neonatology. 2019;115:116-126. google scholar
- Pryds O, Edwards A D. Cerebral blood flow in the newborn infant. Arch Dis Child Fetal Neonatal Ed. 1996;74:F63-F69. google scholar
- Vannucci CR, Vannucci. SJ Hypoglycemic brain injury. Semin Neonatal. 2001;6:147-155. google scholar
- Bozzetti V, Paterlini G, van Bel F, Visser GHA, Tosetti L, Gazzolo D, et al. Cerebral and somatic NIRS- determined oxygenation in IUGR preterm infants during transition. J Matern Fetal Neonatal Med. 2016;29:443-446. google scholar
- Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after asymptomatic neonatal hypoglycemia. Pediatrics. 2008;122(1):65-74. google scholar
- Kinnala A, Rikalainen H, Lapinleimu H, Parkkola R, Kormano M, Kero P. Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 1999;103(4 Pt 1):724-729. google scholar
- Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. BMJ. 1998;297(66-59):1304-1308. google scholar
- McKinlay CJD, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of neonatal hypoglycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171(19):972-983. google scholar
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Paediatrics |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 30, 2023 |
| Published in Issue | Year 2023 |