Regional oxygen saturation of the brain during birth transition of term infants: comparison between elective cesarean and vaginal deliveries.

OBJECTIVE: To evaluate differences in regional oxygen saturation of the brains of term infants of vaginal or cesarean deliveries. STUDY DESIGN: Vaginal delivery (n = 63) and elective cesarean delivery infants were prospectively evaluated for the first 10 minutes after delivery. Peripheral arterial oxygen saturation (SpO(2)) and heart rate were measured on the right hand using pulsoximetry with near infrared spectroscopy. Regional oxygen saturation of the brain (rSO(2)brain) was measured. Fractional tissue oxygen extraction was calculated for each minute. RESULTS: From 4 to 8 minutes, SpO(2) values for cesarean delivery infants were significantly lower than for vaginally delivered infants. Heart rate of the cesarean delivery infants was significantly lower throughout the whole observation period. There was no difference between groups in rSO(2)brain. Fractional tissue oxygen extraction only differed at minute 10. CONCLUSIONS: Although SpO(2) and heart rate were significantly lower in cesarean-delivered infants, there were no differences in rSO(2)brain with respect to mode of delivery.

Inpatient tube weaning in children with long-term feeding tube dependency: A retrospective analysis.

This study investigates the outcome of an intervention program to establish oral feeding after prolonged tube feeding in children. The intervention is based on supervised reduction of enteral formula within a few days supported by a 3-week program of speech therapy, occupational therapy, psychoanalytically based eating therapy, physical therapy, psychodynamic coaching, and nutritional counseling of the infant and his or her parents. Two hundred twenty-one cases were included in this study. All patients had been severely ill or were handicapped and had been exclusively fed by tube for most of their lives. The major outcome variable was complete discontinuation of tube feeding with sufficient oral feeding after treatment, defined as the child's ability to sustain stable body weight by self-motivated oral feeding. Two hundred three patients (92%) were completely fed orally after treatment. Tube feeding was discontinued completely within 8 days in mean, and mean in-patient treatment time was 21.6 days. The current method can be used by a trained and experienced team to wean tube-dependent children from prolonged tube feeding. Tube weaning should be addressed from the beginning of tube feeding in all children who are expected to restore oral feeding after the phase of nutritional stabilization. Since successful programs are rare, we were motivated to present our results of this elaborate program in this article.

Regional cerebral oxygen saturation in newborn infants in the first 15 min of life after vaginal delivery.

The objective of this study was to evaluate regional oxygen saturation of the brain during immediate transition after birth, and to correlate it with pre-ductal arterial oxygen saturation in newborn infants. The prospective observational study including newborn infants in the first 15 min after spontaneous vaginal delivery and uncomplicated transitional period was undertaken. Regional cerebral oxygen saturation (rSO(2)brain) was measured using near-infrared spectroscopy. Arterial oxygen saturation (SpO(2)) and heart rate (HR) were measured on the right wrist by pulse oximetry. rSO(2)brain, SpO(2) and HR measurements were started immediately after birth and were performed in the first 15 min of life. Cerebral fractional tissue oxygen extraction (FTOE) was calculated for each minute. Of 145 newborn infants, 16 were included and the gender allocation was 31 females (49.2%) and 32 males (50.8%). rSO(2)brain increased rapidly from 39% (2 min) to 69% (5 min), SpO(2) increased from 72% (2 min) to 96% (14 min) and FTOE showed a significant decrease from minute 2 (0.47) until minute 4 (0.30) and an increase between 8 to 13 min. rSO(2)brain increased rapidly after vaginal delivery. Although SpO(2) increased within the first 14 min after delivery, rSO(2)brain showed no further significant changes after 5 min. FTOE decreased in the first 4 min and reached standard values subsequently.